Gonorrhoea

Unemo, Magnus; Seifert, H. Steven; Hook, Edward W.; Hawkes, Sarah; Ndowa, Francis; Dillon, Jo-Anne R.

doi:10.1038/s41572-019-0128-6

Cited by 361 publications

(416 citation statements)

References 223 publications

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“…In a comparison between the antibiotic eras, we found that many core genes are unique for isolates in preantibiotic, golden, and postmodern era (Additional file 3: Table S1). This further indicates that N. gonorrhoeae is evolving into a less diverse species, likely with enhanced fitness, but this enhanced fitness might be challenging to elucidate [32]. Studies regarding the biological fitness of isolates from preantibiotic and postmodern era can elucidate if and why certain clones are more fit and in general successful in their survival and transmission.…”

Section: Discussionmentioning

confidence: 99%

Genomic evolution of Neisseria gonorrhoeae since the preantibiotic era (1928–2013): antimicrobial use/misuse selects for resistance and drives evolution

Golparian

Harris²,

Sánchez-Busó

et al. 2020

BMC Genomics

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Background: Multidrug-resistant Neisseria gonorrhoeae strains are prevalent, threatening gonorrhoea treatment globally, and understanding of emergence, evolution, and spread of antimicrobial resistance (AMR) in gonococci remains limited. We describe the genomic evolution of gonococci and their AMR, related to the introduction of antimicrobial therapies, examining isolates from 1928 (preantibiotic era) to 2013 in Denmark. This is, to our knowledge, the oldest gonococcal collection globally.Methods: Lyophilised isolates were revived and examined using Etest (18 antimicrobials) and whole-genome sequencing (WGS). Quality-assured genome sequences were obtained for 191 viable and 40 non-viable isolates and analysed with multiple phylogenomic approaches.Results: Gonococcal AMR, including an accumulation of multiple AMR determinants, started to emerge particularly in the 1950s-1970s. By the twenty-first century, resistance to most antimicrobials was common. Despite that some AMR determinants affect many physiological functions and fitness, AMR determinants were mainly selected by the use/misuse of gonorrhoea therapeutic antimicrobials. Most AMR developed in strains belonging to one multidrug-resistant (MDR) clade with close to three times higher genomic mutation rate. Modern N. gonorrhoeae was inferred to have emerged in the late-1500s and its genome became increasingly conserved over time.Conclusions: WGS of gonococci from 1928 to 2013 showed that no AMR determinants, except penB, were in detectable frequency before the introduction of gonorrhoea therapeutic antimicrobials. The modern gonococcus is substantially younger than previously hypothesized and has been evolving into a more clonal species, driven by the use/misuse of antimicrobials. The MDR gonococcal clade should be further investigated for early detection of strains with predispositions to develop and maintain MDR and for initiation of public health interventions.

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Section: Discussionmentioning

confidence: 99%

Genomic evolution of Neisseria gonorrhoeae since the preantibiotic era (1928–2013): antimicrobial use/misuse selects for resistance and drives evolution

Golparian

Harris²,

Sánchez-Busó

et al. 2020

BMC Genomics

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“…Belarus. None of these antimicrobials should be recommended for empirical first-line gonorrhoea monotherapy in Belarus, which is in concordance with most settings globally [3,5,[8][9][10][11][12][28][29][30][31][32][33][34]36,37,[39][40][41][42][43][44]. Worryingly, despite the high resistance to ciprofloxacin, the other fluoroquinolones ofloxacin and lomefloxacin remain to be recommended in the 2009…”

Section: Discussionmentioning

confidence: 77%

“…Gonorrhoea is one of the most common sexually transmitted infections (STIs) worldwide [1][2][3]. According to the World Health Organization (WHO), in 2016, 86.9 million new cases of gonorrhoea among adults were estimated [2].…”

Section: Introductionmentioning

confidence: 99%

“…Alarmingly, the level of antimicrobial resistance (AMR) in Neisseria gonorrhoeae to a wide range of drugs has increased worldwide, including to first-line treatment [3,5,[8][9][10][11]. The extended-spectrum cephalosporin (ESC) ceftriaxone is the only remaining option for empiric first-line monotherapy in most countries.…”

Section: Introductionmentioning

confidence: 99%

“…The extended-spectrum cephalosporin (ESC) ceftriaxone is the only remaining option for empiric first-line monotherapy in most countries. However, decreased susceptibility or resistance, in vitro and clinical, to ceftriaxone has emerged in many settings globally [3,5,.…”

Section: Introductionmentioning

confidence: 99%

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Antimicrobial resistance in Neisseria gonorrhoeae isolates and gonorrhoea treatment in the Republic of Belarus, Eastern Europe, 2009-2019

Aniskevich

Shimanskaya

Boiko

et al. 2020

Preprint

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Background: Increasing antimicrobial resistance (AMR) in Neisseria gonorrhoeae , including to first-line treatment options, is a great concern worldwide. However, very limited gonococcal AMR data are available in Eastern Europe. We investigated the AMR in N. gonorrhoeae isolates (n=522) cultured in three regions of the Republic of Belarus, 2009-2019, antimicrobial treatment recommended nationally, and treatment given to 1652 gonorrhoea patients in two of the regions (Minsk, 2013-2018; Mogilev, 2010-2019). Methods: Determination of minimum inhibitory concentrations (MICs) of eight antimicrobials was performed using Etest and, where available, resistance breakpoints from the European Committee on Antimicrobial Susceptibility Testing were applied. β-lactamase production was examined using a Nitrocefin test. Gonorrhoea treatment was analysed from medical records. Results: In total, 27.8% of isolates were resistant to tetracycline, 24.7% to ciprofloxacin, 7.0% to benzylpenicillin, 2.7% to cefixime, and 0.8% to azithromycin. No isolates were resistant to ceftriaxone, spectinomycin, or gentamicin. However, four (0.8%) isolates had a ceftriaxone MIC of 0.125 mg/L, which is exactly at the resistance breakpoint (MIC>0.125 mg/L). Only one (0.2%) isolate, from 2013, produced β-lactamase. From 2009-2019, the levels of resistance to ciprofloxacin and tetracycline were relatively stably high. Resistance to cefixime was not identified before 2013, but peaked at 22.2% in 2017. Only sporadic isolates with resistance to azithromycin were found in 2009 (n=1), 2012 (n=1) and 2018-2019 (n=2). Overall, 862 (52.2%) patients received first-line treatment in accordance with national guidelines (ceftriaxone 1 g). However, 154 (9.3%) patients received a nationally recommended alternative treatment (cefixime 400 mg or ofloxacin 400 mg), and 636 (38.5%) patients were given treatment non-compliant to the Belarusian national gonorrhoea guideline. Conclusions: Ceftriaxone 1 g, in combination with azithromycin 2 g particularly when chlamydial infection has not been excluded, should be recommended as empiric first-line treatment. Spectinomycin 2 g, where available, together with azithromycin 2 g could be an alternative treatment. When susceptibility has not been confirmed by testing, fluoroquinolones should not be used for treatment. Timely updating of and high compliance to national evidence-based gonorrhoea treatment guidelines that are based on quality-assured AMR data is imperative. Continued and expanded gonococcal AMR surveillance in Belarus is crucial.

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Diagnosis and Treatment of Sexually Transmitted Infections

Tuddenham

Hamill

Ghanem

2022

JAMA

145

136

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In 2019, an estimated 2.55 million new sexually transmitted infections (STIs) were reported in the US, 1 with a projected direct medical cost of approximately $1.1 billion for gonorrhea, chlamydia, and syphilis in 2018. 2 In 2018, there were approximately 67.6 million prevalent infections in the US, suggesting that an estimated 1 in 5 adults had an STI. 3 People with STIs are at greater risk of transmitting HIV to others. Among people without HIV, STIs increase rates of HIV acquistion. 4,5 STIs also increase rates of infertility, chronic pelvic pain, ectopic pregnancy, miscarriage, fetal death, and congenital and neonatal infections. [6][7][8][9] This review summarizes current evidence regarding the epidemiology, diagnosis, treatment, and prevention of gonorrhea, chlamydia, syphilis, Mycoplasma genitalium, trichomoniasis, and genital herpes. For the purposes of clarity, in this article, the terms male and female refer to those assigned male or female at birth, respectively (see eTable 1 in the Supplement for additional clinician resources). MethodsWe searched PubMed and Cochrane databases using Medical Subject Headings for English-language studies of the epidemiology, diagnosis, and treatment of gonorrhea, chlamydia (including lymphogranuloma venereum), syphilis, Mycoplasma genitalium, trichomoniasis, and herpes simplex virus type 1 (HSV-1) and type 2 (HSV-2) between October 1, 2010, and October 31, 2021. We manually searched the references of selected articles for additional relevant studies (including older studies). Randomized clinical trials, meta-analyses, systematic reviews, and national and international clinical practice guidelines were prioritized for inclusion. Of 1896 reports identified, 81 were included, consisting of 8 randomized trials, 7 meta-analyses, 27 systematic reviews, 5 clinical practice guidelines, 28 observational studies, 3 modeling studies, and 3 retrospective case series. IMPORTANCE Approximately 1 in 5 adults in the US had a sexually transmitted infection (STI) in 2018. This review provides an update on the epidemiology, diagnosis, and treatment of gonorrhea, chlamydia, syphilis, Mycoplasma genitalium, trichomoniasis, and genital herpes.OBSERVATIONS From 2015 to 2019, the rates of gonorrhea, chlamydia, and syphilis increased in the US; from 1999 to 2016, while the rates of herpes simplex virus type 1 (HSV-1) and HSV-2 declined. Populations with higher rates of STIs include people younger than 25 years, sexual and gender minorities such as men and transgender women who have sex with men, and racial and ethnic minorities such as Black and Latinx people. Approximately 70% of infections with HSV and trichomoniasis and 53% to 100% of extragenital gonorrhea and chlamydia infections are asymptomatic or associated with few symptoms. STIs are associated with HIV acquisition and transmission and are the leading cause of tubal factor infertility in women. Nucleic acid amplification tests have high sensitivities (86.1%-100%) and specificities (97.1%-100%) for the diagnosis of gonorrhea, chlamydia,...

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Gonorrhoea

Cited by 361 publications

References 223 publications

Genomic evolution of Neisseria gonorrhoeae since the preantibiotic era (1928–2013): antimicrobial use/misuse selects for resistance and drives evolution

Genomic evolution of Neisseria gonorrhoeae since the preantibiotic era (1928–2013): antimicrobial use/misuse selects for resistance and drives evolution

Antimicrobial resistance in Neisseria gonorrhoeae isolates and gonorrhoea treatment in the Republic of Belarus, Eastern Europe, 2009-2019

Diagnosis and Treatment of Sexually Transmitted Infections

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