Detection of 10 cases of ceftriaxone-resistant Neisseria gonorrhoeae in the United Kingdom, December 2021 to June 2022

Abstract

Between December 2021 and June 2022, 10 cases of ceftriaxone-resistant Neisseria gonorrhoeae (ST8123; n = 8) were detected in the United Kingdom, compared with nine cases during the previous 6 years. Most of these cases were associated with travel from the Asia-Pacific region; all were heterosexual people, with most in their 20s. Although all cases were successfully treated, not all partners of cases could be traced, and there is a risk of further transmission of ceftriaxone-resistant gonococcal infection within the UK.

Ceftriaxone-resistant, multidrug-resistant Neisseria gonorrhoeae with a novel mosaic penA-237.001 gene, France, June 2022

“…respectively [5,7,14]. However, F92 is closely related to the recently reported UK722 isolate described in the United Kingdom (Case 9) [12] with identical genotypes and only 42 SNP differences. Phylogenomic comparison to other gonococcal genomes (n = 36,310) showed that F92 belonged to the genomic sublineage A2, where ceftriaxone-resistant isolates have been previously identified.…”

“…Resistance to ESCs was conferred by the novel mosaic penA allele designated as penA-237.001, encoding an amino acid sequence 99.1% identical (i.e. five substitutions: P328A, A480P, S483T, I485T and T534A; nucleotide identity: 98.7%) to that encoded by penA-60.001, which causes ESC resistance in the internationally spreading FC428 clone [5,[7][8][9][10][11][12]. The penA-237.001 encodes a mosaic penicillin-binding protein 2 (PBP2) including the amino acid substitutions A311V, I312M, V316T and G545S associated with ESC resistance [13].…”

“…Phylogenomic comparison to other gonococcal genomes (n = 36,310) showed that F92 belonged to the genomic sublineage A2, where ceftriaxone-resistant isolates have been previously identified. However, the ceftriaxone-resistant MDR F92 isolate was very distant from the internationally spreading FC428 clone [8][9][10][11][12][13] (Figure 1). F92 instead clustered with several of the mostly recently detected Asian MLST ST1901 and ST1579 isolates (Figure 2); the three most similar isolates (MLST ST1901) differed by 1,381-1,392 SNPs.…”

“…The F92 isolate from France (red arrow) is compared with other ceftriaxone-resistant gonococcal strains (blue arrows and circles), among publicly available gonococcal genomes (n = 36,310) downloaded from the European Nucleotide Archive using the search term 'Taxon:485' (on 4 August 2022). The internationally spreading ceftriaxone-resistant FC428 clade (including isolates F90 and F91) [5,[7][8][9][10][11][12], the closely related UK722 isolate [12], the first described ceftriaxone-resistant extensively drug-resistant WHO X [21] and WHO Y (F89) [14] strains, and the first two strains with ceftriaxone resistance combined with high-level azithromycin resistance, i.e. AT159 [6] and WHO Q [22], are shown.…”

“…The penA-237.001 encodes a mosaic penicillin-binding protein 2 (PBP2) including the amino acid substitutions A311V, I312M, V316T and G545S associated with ESC resistance [ 13 ]. One NG isolate with penA-237.001 (isolate UK722) was recently isolated from a female patient described in the United Kingdom [ 12 ]. Many additional resistance determinants generated the multidrug-resistant (MDR) phenotype ( Table ), e.g.…”