P675 Two recent cases of extensively drug-resistant (XDR) gonorrhoea in the united kingdom linked to a european party destination

Abstract

cefixime, ceftriaxone, azithromycin, ciprofloxacin and penicillin were defined according to EUCAST 4.0 standards. Results Of 2115 isolates, 91.6% of isolates were from men. The most frequently tested materials among men were urethral (92.4%) and rectal swabs (3.8%), and among women mainly endocervical swabs (80.9%). Resistance to ceftriaxone (MIC !0.125 mg/L) occurred only sporadically (0-0.3%) during the entire observation period (2015 and 2018), while 1.0-2.1% of isolates were resistant to cefixime (MIC !0.125 mg/ L). Proportion of isolates resistant to azithromycin (MIC ! 0.5 mg/L) was 11.4% (2014), 11.3% (2015), 4.3% (2016), 3.7% (2017), 9.4% (2018). 53.4-71.7% were resistant to ciprofloxacin, and 14.2-24.3.1% were resistant to penicillin. Conclusion Resistance to ceftriaxone and to cefixime was low, whereas azithromycin resistance showed a discontinuous presentation with partly high levels during the observation period. Rates of ciprofloxacin and penicillin resistance were very high. According to the current national guidelines, ceftriaxone 1-2g IV and azithromycin 1,5g orally are usually used in dual therapy. Shortly revised national guidelines will state that use of azithromycin should be avoided if possible if a test of cure can be guaranteed and a susceptibility test is available. Continued surveillance of NG AMR remains relevant to ensure efficient disease management. Disclosure No significant relationships.

Modelling outbreak response strategies for preventing spread of emergent Neisseria gonorrhoeae strains in men who have sex with men in Australia

“…In this modelling study we show that dissemination of emergent or imported strains of NG can be contained in a simulated Australian urban MSM population using moderately intense combinations of population-based and case-based testing/treatment strategies. The work is motivated by recent reports from Australia and the UK of imported XDR NG strains (5, 7, 16), including those with documented ceftriaxone/azithromycin dual treatment failure for oropharyngeal infection (7, 8) and the potential for outbreaks that are difficult and expensive to control (19). For instance, analysis of the historical rise in Australia of ciprofloxacin resistance (13) suggests that once resistant NG had become established overseas, variants of these resistant strains were repeatedly imported into Australia, leading eventually to a requirement to change the recommended treatment.…”

“…The prevalence of gonorrhoea in Australia is highest in remote Aboriginal and Torres Strait Islander populations and among men who have sex with men (MSM) in metropolitan centres. Although to date most reported cases of XDR NG have involved heterosexual contact (5, 7, 8, 16), we have chosen to focus on MSM due to the high incidence of gonorrhoea in this population, frequent sexual contact when travelling overseas, and evidence of the importance of oropharyngeal NG in driving transmission in this population (17, 18). These factors together suggest that establishment of an XDR NG strain within an MSM population could spark a rapidly expanding gonorrhoea epidemic that would be difficult to contain (19).…”

Modelling response strategies for controlling gonorrhoea outbreaks in men who have sex with men in Australia

“…The prevalence of gonorrhoea in Australia is highest in remote Aboriginal and Torres Strait Islander populations and among men who have sex with men (MSM) in metropolitan centres. Although to date most reported cases of XDR NG have involved heterosexual contact [ 5 , 7 , 8 , 16 ], we have chosen to focus on MSM due to the high incidence of gonorrhoea in this population, frequent sexual contact when travelling overseas, and evidence of the importance of oropharyngeal NG, which is more difficult to treat, in driving transmission in this population [ 17 , 18 ]. These factors together suggest that establishment of an XDR NG strain within an MSM population could spark a rapidly expanding gonorrhoea epidemic that would be difficult and costly to contain [ 19 ].…”

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“…In this modelling study we show that dissemination of imported strains of NG can be contained in a simulated Australian urban MSM population using moderately intense combinations of population-based and case-based testing/treatment strategies. The work is motivated by recent reports from Australia and the UK of imported XDR NG strains [5,7,16], including those with documented ceftriaxone/azithromycin dual treatment failure for oropharyngeal infection [7,8] and the potential for outbreaks that are difficult and expensive to control [19]. For instance, analysis of the historical rise in Australia of ciprofloxacin resistance [13] suggests that once resistant NG had become established overseas, variants of these resistant strains were repeatedly imported into Australia, leading eventually to a requirement to change the recommended treatment.…”

“…On their behalf, the corresponding author has reported their contributions to the best of their knowledge. [5,7,8,16], we have chosen to focus on MSM due to the high incidence of gonorrhoea in this population, frequent sexual contact when travelling overseas, and evidence of the importance of oropharyngeal NG, which is more difficult to treat, in driving transmission in this population [17,18]. These factors together suggest that establishment of an XDR NG strain within an MSM population could spark a rapidly expanding gonorrhoea epidemic that would be difficult and costly to contain [19].…”