Resistant gonorrhea infection reported in England

A male patient in England was recently confirmed to have the first infection of Neisseria gonorrhoeae resistant to first-line treatment with ceftriaxone and azithromycin. The high-level resistant pathogen was found to be susceptible only to spectinomycin, which is not currently available in the United States.

“We are investigating a case who has gonorrhea which was acquired abroad and is very resistant to the recommended first-line treatment,” said Gwenda Hughes, PhD, FFPH, consultant scientist and head of Sexually Transmitted Infection Section at Public Health England (PHE). “First-line treatment for gonorrhea is a combination of 2 antibiotics (azithromycin and ceftriaxone). This is the first time a case has displayed such high-level resistance to both of these drugs and to most other commonly used antibiotics.”

The strain was isolated in early 2018. The patient has a regular female sexual partner in the United Kingdom and reported sexual contact with another female in southeast Asia one month before the onset of symptoms.

He received empiric ceftriaxone and subsequent treatment with spectinomycin. At follow-up, test-of-cure (TOC) with urine nucleic acid amplification testing was negative, but a throat swab culture was positive. The patient was not determined to have reinfection, so treatment failure was suspected.

Current treatment includes IV ertapenem. The minimum inhibitory concentration of ertapenem was low in this patient, which suggests the therapy may be effective, although there are no defined breakpoints.

Results of the next TOC will be available in mid-April 2018. The PHE is currently supporting clinical and microbiology teams during the patient’s management, and an incident management team will coordinate the investigation and avoid additional spread of the infection.

“We are following up this case to ensure that the infection was effectively treated with other options and the risk of any onward transmission is minimized,” said Dr. Hughes. “PHE actively monitors, and acts on, the spread of antibiotic resistance in gonorrhea and potential treatment failures, and has introduced enhanced surveillance to identify and manage resistant strains of infection promptly to help reduce further spread.”