O07 Reduced susceptibility of pharyngealNeisseria gonorrhoeaeinfections to current recommended therapeutics in England and Wales using national surveillance data (GRASP)

Abstract

Background

Neisseria gonorrhoeae (NG) infection in the pharynx is more difficult to treat than infections at other sites. Persistent NG infection may develop antimicrobial resistance by genetic exchange of resistance determinants with commensal Neisseria species in the pharynx. Using data between 2012–2020 from the Gonococcal Resistance to Antimicrobials Surveillance Programme (GRASP), we investigated the association between anatomical site of infection and reduced susceptibility or resistance to therapeutically relevant antimicrobials among NG positive individuals attending sexual health services in England and Wales.

Methods

Multivariate logistic regression was used to investigate the association between site of infection (pharyngeal vs genital, pharyngeal vs rectal) and resistance (R) or reduced susceptibility (RS) to azithromycin (R at minimum inhibitory concentration (MIC)>0.5 mg/L), ceftriaxone (RS at both MIC>0.015 mg/L and MIC>0.03 mg/L), cefixime (RS at MIC>0.06 mg/L; R at MIC>0.125 mg/L) and ciprofloxacin (R at MIC>0.06 mg/L) among GBMSM and heterosexual women.

Results

In total, 10,275 NG isolates were included; 8,402 (82%) were from GBMSM and 1,873 (18%) from heterosexual women. Pharyngeal isolates comprised 13% of isolates from GBMSM and 6% from heterosexual women. Among GBMSM, pharyngeal infections were significantly associated with RS to ceftriaxone (MIC>0.03 mg/L) compared to both genital (aOR: 1.76, p=0.009) and rectal infections (aOR: 2.15, p<0.001). Among heterosexual women, pharyngeal infections were associated with RS to ceftriaxone (MIC>0.015 mg/L) (aOR: 1.93, p=0.03) and RS to cefixime (aOR: 2.49, p=0.03) compared to genital infections. No other associations were found.

Discussion

Ceftriaxone resistance remains rare in the UK and undetected through GRASP. However pharyngeal isolates from both GBMSM and heterosexual women were more likely to have RS to ceftriaxone than isolates from other sites. These findings emphasise the importance of extra-genital testing, access to susceptibility testing and test-of-cure to prevent the possibility of widespread treatment failures.