Australian Gonococcal Surveillance Programme Annual Report, 2021

Abstract

The Australian Gonococcal Surveillance Programme, established in 1981, has continuously monitored antimicrobial resistance in Neisseria gonorrhoeae for more than 40 years. In 2021, a total of 6,254 isolates from patients in the public and private sectors, in all jurisdictions, were tested for in vitro antimicrobial susceptibility by standardised methods. The current treatment recommendation for gonorrhoea, for the majority of Australia, continues to be dual therapy with ceftriaxone and azithromycin. In 2021, of isolates tested, 0.9% were reported nationally with decreased susceptibility (DS) to ceftriaxone (minimum inhibitory concentration [MIC] value ≥ 0.06 mg/L). There was one isolate from non-remote Western Australia that was resistant to ceftriaxone (MIC value ≥ 0.25 mg/L). Resistance to azithromycin (MIC value ≥ 1.0 mg/L) was reported nationally in 4.7% of N. gonorrhoeae isolates. This is increased from that reported in 2020 (3.9%) but similar to the percentage reported in 2019 (4.6%). Isolates with high-level resistance to azithromycin (MIC value ≥ 256 mg/L) are identified sporadically in Australia; none were reported in 2021. In 2021, penicillin resistance was found in 38% of gonococcal isolates nationally, and ciprofloxacin resistance in 53%; however, there is considerable variation by jurisdiction. In some remote settings, penicillin resistance remains low; in these settings, penicillin continues to be recommended as part of an empiric therapy strategy. In 2021, in remote Northern Territory, one penicillin-resistant isolate was reported, and in remote Western Australia 2/83 of gonococcal isolates (2.4 %) were penicillin resistant. There were two ciprofloxacin-resistant isolates reported from remote Northern Territory; ciprofloxacin resistance rates remain comparatively low in remote Western Australia (3/83; 3.6 %).

Impact of COVID-19 Containment Strategies and Meningococcal Conjugate ACWY Vaccination on Meningococcal Carriage in Adolescents

“…8 In South Australia, IMD cases decreased from 36 in 2017, 34 in 2018, 27 in 2019, to 5 in 2020. 9,10 The observed reduction in IMD in 2020 followed the introduction of a 4CMenB infant program beginning October 2018, and an adolescent program commencing February 2019, with 1 year of catch up for 16-20-yearolds. An adolescent MenACWY program for adolescents was also introduced in April 2019.…”

Response to the ASHM 2023 statement on the use of doxy‐PEP in Australia: considerations and recommendations

“…Tetracycline resistance is rarely documented in Chlamydia trachomatis or Treponema palladium; 21 however, Neisseria gonorrhoeae can develop and maintain resistance to tetracyclines as well as the other antimicrobials, with mutations conferring coresistance. 22 The Statement acknowledges doxy-PEP is unlikely to be an effective gonorrhoea control strategy, given high gonococcal tetracycline resistance (45%) in Australia, 23 with higher rates likely among GBMSM. 24 However, STI co-infection frequently occurs.…”

Interim position statement on doxycycline post-exposure prophylaxis (Doxy-PEP) for the prevention of bacterial sexually transmissible infections in Australia and Aotearoa New Zealand – the Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM)

“…Effectiveness against gonorrhoea will likely depend on background tetracycline resistance in gonococci, which currently sits at approximately 41% in Australia nationally, and at 51% in the state of Victoria, which is the highest level in the country, and at 35% in AoNZ. 14,15 It is postulated that the lack of effectiveness against gonorrhoea in the French ANRS Ipergay substudy, and the relatively lower effectiveness in the French Doxyvac study may have been due to relatively high background rates of tetracycline resistance in gonorrhoea isolates in France. 13 Other antibiotics are unlikely to be suitable as Doxy-PEP, particularly against syphilis, which is the bacterial STI with the most serious common clinical manifestations.…”