Rapid spread ofNeisseria gonorrhoeaeciprofloxacin resistance due to a newly introduced resistant strain in Nuuk, Greenland, 2012–2015: a community-based prospective cohort study

Abstract

ObjectivesTo determine the antimicrobial susceptibility and genotype distribution of Neisseria gonorrhoeae strains isolated from a cohort of patients in Nuuk, Greenland in order to assess the risk of rapid spread in the event of introduction of new strains.MethodsGonococcal isolates (n=102) obtained from a prospective cohort study of ciprofloxacin resistance were collected between March 2012 and February 2013. Etest minimal inhibitory concentrations (MICs) were determined for ciprofloxacin, azithromycin, ceftriaxone, penicillin, tetracycline, spectinomycin and gentamicin. All isolates were subjected to molecular typing using N. gonorrhoeae multiantigen sequence typing (NG-MAST). After the introduction of a ciprofloxacin-resistant strain in early 2014, an additional 18 isolates were characterised.ResultsDuring the study period, all 102 isolates were fully susceptible to ciprofloxacin (≤0.03 mg/L), azithromycin, spectinomycin, gentamicin and ceftriaxone. 10 different NG-MAST types circulated in Nuuk but 7 were found as single isolates, and 3 of the 7 belonged to 1 of the 3 major genogroups (G210, G9816 and G9817) together comprising 96% of the 102 isolates. ST210 accounted for 55% of the 102 strains. The newly introduced ciprofloxacin resistant strain belonged to ST2400 and dominated the population with 59% resistant strains within 6 months after its introduction. All G2400 strains had MICs≥2 mg/L.ConclusionsIntroduction of a ciprofloxacin-resistant strain into a very homogeneous N. gonorrhoeae population led to an explosive spread of the resistant clone, probably as a result of large sexual networks suggested by the strain homogeneity. Careful surveillance of antimicrobial susceptibility is essential to avoid widespread treatment failure in closed populations.

Gonorrhoea in Greenland: geographic differences in diagnostic activity and incidence of gonorrhoea in 2015

“…This growth of antimicrobial resistance calls for an immediate effective approach in order to prevent and control the spread of gonorrhoea as well as other STIs [4,10,17,26,27]. …”

“…All tests are marked with an area code and are analysed and registered at The Central Laboratory at Queen Ingrid’s Hospital in Nuuk. Thus, all patients diagnosed with gonorrhoea can be identified including age, gender and region where the tests have been obtained [10,16]. All patients with positive gonorrhoea tests are offered a combination treatment of 500 mg ceftriaxone i.m.…”

“…All patients with positive gonorrhoea tests are offered a combination treatment of 500 mg ceftriaxone i.m. and azithromycin 2 g according to European guidelines [10,17,18]. …”

“…However, throughout the recent decade the incidence of gonorrhoea in Greenland has begun to increase again (From 872 cases in 2002 to 1,550 cases in 2014 [8,9]). This increase in gonorrhoea incidence corresponds to an equivalent increase in both chlamydia and syphilis cases [10], and demonstrates the need for continuous focus on STIs in Greenland. Especially among young adults, an increased risk of infection has been detected [11].…”

“…Both nationally and locally the Greenlandic health authorities have launched several initiatives through the years in order to reduce the incidence of gonorrhoea and other STIs. Implementation of new diagnostic methods, enhancement of infection surveillance and screening, and public campaigns and interventions such as peer-to-peer programmes in schools are some of these initiatives [10,12,13]. Furthermore, sexual health education is mandatory in the public school in Greenland, all proving that authorities have an interest in improving sexual health in Greenland.…”