Analysis of gonorrhea samples in Cambodia found sustained transmission of ceftriaxone-resistant strains and a threefold jump in extensively drug-resistant (XDR) isolates, researchers reported this week in Emerging Infectious Diseases.
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For the study, researchers with Cambodia's National Center for HIV/AIDS, Dermatology, and Sexually Transmitted Diseases and the World Health Organization (WHO) performed antimicrobial susceptibility tests and genomic analysis on 72 Neisseria gonorrhoeae isolates collected in 2023 through the WHO's Enhanced Gonococcal Antimicrobial Surveillance Program (EGASP). Under EGASP protocols, public health alerts are sent upon identification of strains approaching resistance.
A 'substantial threat' for gonorrhea control
EGASP alert minimum inhibitory concentrations (MICs) for ceftriaxone and cefixime—two first-line treatment options for gonorrhea—were detected in 22 (31%) of 72 isolates, a proportion similar to that reported in 2022 (38%). But 9 isolates (12.5%) had the XDR phenotype, which combines ceftriaxone resistance and high-level azithromycin resistance, and all belonged to the same sequence type (ST-16406). That's up from 4% in 2022. In addition, the percentage of isolates with high resistance to ciprofloxacin and penicillin remained high (82% to 97%).
Genomic analysis of 54 isolates with ceftriaxone alert MICS in 2022 and 2023 found that 50 carried the same resistance mutation (the penA-60.001 allele), and 4 harbored recently described or novel mutations. Furthermore, sequences from only 8 isolates clustered with a widely disseminated, ceftriaxone-resistant clone (FC428).
"Our data provide further evidence for sustained transmission of N. gonorrhoeae strains with elevated MICs for ceftriaxone and increased expansion of isolates with elevated MICs to ceftriaxone and azithromycin that genomically cluster with the XDR N. gonorrhoeae phenotype," the study authors wrote. "Furthermore, strains with elevated MICs for ceftriaxone continue to emerge across different phylogenetic backbones separate from the previously described FC428 clone, confirming concerns that biological fitness is not compromised by that allele and consequently poses a substantial threat for gonococcal disease control."
They add that the findings, combined with recent reports of rising ceftriaxone resistance in China, highlight the need to prioritize gonococcal antimicrobial resistance surveillance across the Asia-Pacific region.