New surveillance data released today by the European Centre for Disease Prevention and Control (ECDC) shows dramatically rising antimicrobial resistance (AMR) amid a substantial increase in gonorrhea infections.
Of the 4,396 Neisseria gonorrhoeae isolates submitted by 23 European Union/European Economic Area (EU/EEA) countries to the European Gonococcal Antimicrobial Surveillance Programme in 2022, 25.6% were resistant to azithromycin, compared with 14.2% in 2021. This is noteworthy, because, although ceftriaxone is the recommended antibiotic for treating gonorrhea throughout Europe and elsewhere, azithromycin is often used in combination with ceftriaxone to ensure treatment success.
In addition, two isolates with resistance to ceftriaxone were detected—one each in Austria and Germany. One isolate was extensively drug-resistant and the other multidrug-resistant, with one displaying "high-level" azithromycin resistance.
ECDC officials say the detection of ceftriaxone resistance, in combination with rising azithromycin resistance, is a worrying trend.
"Although dual ceftriaxone and azithromycin resistance is exceedingly rare in the EU/EEA, the rapidly decreasing azithromycin susceptibility combined with the continued detection of occasional ceftriaxone resistance is still of concern and threatens the effectiveness of treatment and control of gonorrhea," the ECDC said in an executive summary.
Gonorrhea cases up 48%
The data also show that resistance to ciprofloxacin, which can be an alternative treatment when isolates are shown to be susceptible, rose to 65.9% from 62.8% in 2021 and 57.7% in 2020. Cefixime resistance remained low, at 0.3%, but ECDC officials cautioned that it needs to be monitored closely, since gonococcal strains with resistance to both ceftriaxone and cefixime are spreading internationally.
The rise in drug resistance was accompanied by a dramatic rise in gonorrhea infections. A total of 70,881 confirmed cases were reported from 28 EU/EEA countries in 2022, a 48% increase from 2021.
Although dual ceftriaxone and azithromycin resistance is exceedingly rare in the EU/EEA, the rapidly decreasing azithromycin susceptibility combined with the continued detection of occasional ceftriaxone resistance is still of concern and threatens the effectiveness of treatment and control of gonorrhea.
Although a strong majority of gonococcal isolates were from men (80.9%), a significant increase was seen in the proportion of specimens from women—19.1% compared with 13.9% in 2021. The proportion of samples from people under 25 rose to 28.4%, up from 23.2% in 2021.
The ECDC said that while investments in new antibiotics and alternative regimens will be necessary to stay ahead of the evolving resistance in gonorrhea, stronger antimicrobial susceptibility surveillance and public health initiatives aimed at reducing the number of gonorrhea infections—including increased access to testing and early treatment—are also needed to ensure that it remains a treatable infection.
"ECDC stresses the importance of prevention in curbing the spread of gonorrhoea and mitigating the risk of AMR," the agency said in a news release.
