High tetracycline and azithromycin resistance of Neisseria gonorrhoeae impacting treatment and doxyPEP use - antimicrobial susceptibility patterns of isolates from a prospective cohort of men who have sex with men in Wroclaw, Lower Silesia, Poland 2022-2024 - final report.

Abstract

Objectives: The aim was to ascertain Neisseria gonorrhoeae (NG) antimicrobial resistance patterns among men who have sex with men (MSM), evaluate their impact on treatment and prophylaxis, identify risk factors for infection, and assess whether expanding the sample size beyond the preliminary cohort significantly altered the primary outcomes (1).

Methods: This trial was conducted at the outpatient All Saints' HIV clinic in Wroclaw, Poland, between 2022 and 2024. Rectal, urethral, and oropharyngeal swabs were collected from 200 MSM who were wither living with HIV (PLWH) or using pre-exposure prophylaxis (PrEP). Included participants reported high-risk sexual contacts, symptoms, or prior positive results. NG isolates were evaluated for susceptibility to ceftriaxone, cefixime, azithromycin, ciprofloxacin, tetracycline, and benzylpenicillin.

Results: Of the 200 MSM enrolled, 33.5% were PLWH and 66.5% were PrEP users. This extended analysis identified 23 additional isolates alongside the initial 26, yielding 43 viable isolates for susceptibility testing. PrEP users were slightly younger than PLWH (median 34 vs. 36 years) and reported more oral contacts, more sexual partners outside of Poland, and more partners of foreign nationality within Poland. Doxycycline post-exposure prophylaxis (doxyPEP) was more frequently utilized by PLWH (30.3% vs. 14.18%). NG culture positivity rates were similar between PLWH (21.7%) and PrEP users (23.3%). In multivariate logistic regression, NG infection was significantly associated with higher number of oral contacts (OR = 4.05; 95% CI: 1.15-14.27; p = 0.029). While all isolates retained full susceptibility to ceftriaxone and cefixime, resistance to azithromycin was 30.2% (13/43) and tetracycline 48.8% (21/43), demonstrating stability between the preliminary and final analyses.

Conclusions: Ceftriaxone and cefixime remain highly effective first-line agents against NG in Poland, whereas high resistance rates dictate that azithromycin should be relegated to alternative therapy status in national guidelines. Furthermore, the high prevalence of tetracycline resistance may compromise the efficacy of doxyPEP. Finally, the initial cohort of 100 MSM was statistically sufficient to accurately ascertain core antimicrobial resistance patterns.

Clinical trial number: Not applicable.