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de Vries, H. J., de Barbeyrac, B., de Vrieze, N. H., Viset, J. D., White, J. A., Vall-Mayans, M. & Unemo, M. (2019). 2019 European guideline on the management of lymphogranuloma venereum. Journal of the European Academy of Dermatology and Venereology
Open this publication in new window or tab >>2019 European guideline on the management of lymphogranuloma venereum
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2019 (English)In: Journal of the European Academy of Dermatology and Venereology, ISSN 0926-9959, E-ISSN 1468-3083Article in journal (Refereed) Epub ahead of print
Abstract [en]

New or important issues in this updated version of the 2013 European guideline on the management of lymphogranuloma venereum (LGV): EPIDEMIOLOGY: Lymphogranuloma venereum continues to be endemic among European men who have sex with men (MSM) since 2003. Lymphogranuloma venereum infections in heterosexuals are extremely rare in Europe, and there is no evidence of transmission of LGV in the European heterosexual population.

AETIOLOGY AND TRANSMISSION: Chlamydia trachomatis serovars/genovars L2b and L2 are the causative strains in the majority of cases in Europe.

CLINICAL FEATURES: Among MSM, about 25% of the anorectal LGV infections are asymptomatic. Genital infections among MSM are rare; the ratio of genital vs. anorectal LGV infections is 1 in 15.

DIAGNOSIS: To diagnose LGV, a sample tested C. trachomatis positive with a commercial nucleic acid amplification test (NAAT) platform should be confirmed with an LGV discriminatory NAAT.

TREATMENT: Doxycycline 100 mg twice a day orally for 21 days is the recommended treatment for LGV. This same treatment is recommended also in asymptomatic patients and contacts of LGV patients. If another regimen is used, a test of cure (TOC) must be performed.

Place, publisher, year, edition, pages
Blackwell Publishing, 2019
National Category
Infectious Medicine
Identifiers
urn:nbn:se:oru:diva-75615 (URN)10.1111/jdv.15729 (DOI)31243838 (PubMedID)
Available from: 2019-08-20 Created: 2019-08-20 Last updated: 2019-08-20Bibliographically approved
Boiko, I., Golparian, D., Krynytska, I., Bezkorovaina, H., Frankenberg, A., Onuchyna, M., . . . Unemo, M. (2019). Antimicrobial susceptibility of Neisseria gonorrhoeae isolates and treatment of gonorrhoea patients in Ternopil and Dnipropetrovsk regions of Ukraine, 2013-2018. Acta Pathologica, Microbiologica et Immunologica Scandinavica (APMIS), 127(7), 503-509
Open this publication in new window or tab >>Antimicrobial susceptibility of Neisseria gonorrhoeae isolates and treatment of gonorrhoea patients in Ternopil and Dnipropetrovsk regions of Ukraine, 2013-2018
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2019 (English)In: Acta Pathologica, Microbiologica et Immunologica Scandinavica (APMIS), ISSN 0903-4641, E-ISSN 1600-0463, Vol. 127, no 7, p. 503-509Article in journal (Refereed) Published
Abstract [en]

Antimicrobial resistance (AMR) in Neisseria gonorrhoeae is a major public health concern globally. However, recent gonococcal AMR data from Eastern Europe are extremely limited and no AMR data for strains spreading in Ukraine have ever been internationally published. We investigated the AMR of N. gonorrhoeae isolates in two regions of Ukraine (Ternopil 2013-2018, Dnipropetrovsk 2013-2014), and, where information was available, the treatment administered to the corresponding gonorrhoea patients. Determination of minimum inhibitory concentration (MIC) of eight antimicrobials was performed using Etest and resistance breakpoints from the European Committee on Antimicrobial Susceptibility Testing (EUCAST) were applied. Overall, 9.3% of the examined 150 isolates were resistant to ciprofloxacin, 6.0% to tetracycline, 2.0% to azithromycin, and 0.7% to benzylpenicillin. No isolates were resistant to ceftriaxone, cefixime, spectinomycin, or gentamicin. However, one (0.7%) isolate showed a MIC value of 0.125 mg/L for both ceftriaxone and cefixime, i.e., bordering resistance. Eighty-eight (67.2%) of 131 patients were administered dual therapy (ceftriaxone 1 g plus doxycycline/clarithromycin/azithromycin/ofloxacin) and 22 (16.8%) ceftriaxone 1 g monotherapy. Worryingly, 21 (16.0%) patients received monotherapy with clarithromycin/doxycycline/azithromycin/ofloxacin/benzylpenicillin. In conclusion, the antimicrobial susceptibility of gonococcal strains spreading in Ternopil and Dnipropetrovsk, Ukraine during 2013-2018 was high. Low levels of resistance to ciprofloxacin, tetracycline, azithromycin, and benzylpenicillin were found, but no resistance to the internationally recommended ceftriaxone, cefixime, or spectinomycin. Ceftriaxone 1 g should remain as empiric first-line treatment, in dual therapy with azithromycin or doxycycline or in monotherapy. Continued and expanded gonococcal AMR surveillance in Ukraine is essential to monitor the susceptibility to particularly extended-spectrum cephalosporins, azithromycin and doxycycline.

Place, publisher, year, edition, pages
John Wiley & Sons, 2019
Keywords
Neisseria gonorrhoeae, Gonorrhoea, antimicrobial resistance (AMR), ceftriaxone, azithromycin, Ukraine
National Category
Immunology in the medical area Microbiology in the medical area
Identifiers
urn:nbn:se:oru:diva-75208 (URN)10.1111/apm.12948 (DOI)000473620900002 ()30903707 (PubMedID)
Available from: 2019-07-26 Created: 2019-07-26 Last updated: 2019-07-26Bibliographically approved
Bruni, M. P., Freitas da Silveira, M., Stauffert, D., Bicca, G. L., Caetano Dos Santos, C., da Rosa Farias, N. A., . . . Unemo, M. (2019). Aptima Trichomonas vaginalis assay elucidates significant underdiagnosis of trichomoniasis among women in Brazil according to an observational study. Sexually Transmitted Infections, 95(2), 129-132
Open this publication in new window or tab >>Aptima Trichomonas vaginalis assay elucidates significant underdiagnosis of trichomoniasis among women in Brazil according to an observational study
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2019 (English)In: Sexually Transmitted Infections, ISSN 1368-4973, E-ISSN 1472-3263, Vol. 95, no 2, p. 129-132Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: Trichomonas vaginalis (TV) infection is the most common non-viral STI globally and can result in adverse pregnancy outcomes and exacerbated HIV acquisition/transmission. Nucleic acid amplification tests (NAATs) are the most sensitive diagnostic tests, with high specificity, but TV NAATs are rarely used in Brazil. We investigated the TV prevalence and compared the performance of the US Food and Drug Association-cleared Aptima TV assay with microscopy (wet mount and Gram-stained) and culture for TV detection in women in Pelotas, Brazil in an observational study.

METHODS: From August 2015 to December 2016, 499 consecutive asymptomatic and symptomatic sexually active women attending a Gynaecology and Obstetrics Outpatient Clinic were enrolled. Vaginal fluid and swab specimens were collected and wet mount microscopy, Gram-stained microscopy, culture and the Aptima TV assay performed.

RESULTS: The median age of enrolled women was 36.5 years (range: 15-77). The majority were white, had a steady sexual partner and low levels of education. The TV detection rate was 4.2%, 2.4%, 1.2% and 0% using the Aptima TV assay, culture, wet mount microscopy and Gram-stained microscopy, respectively. The sensitivity of culture and wet mount microscopy was only 57.1% (95% CI 36.5 to 75.5) and 28.6% (95% CI 13.8 to 50.0), respectively.

CONCLUSIONS: was found among women in Pelotas, Brazil and the routine diagnostic test (wet mount microscopy) and culture had low sensitivities. More sensitive diagnostic tests (NAATs) and enhanced testing of symptomatic and asymptomatic at-risk women are crucial to mitigate the transmission of TV infection, TV-associated sequelae and enhanced HIV acquisition and transmission.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2019
Keywords
Aptima, Brazil, culture, nucleic acid amplification test (NAAT), trichomonas infection, trichomonas vaginalis, wet mount microscopy
National Category
Obstetrics, Gynecology and Reproductive Medicine Infectious Medicine
Identifiers
urn:nbn:se:oru:diva-68678 (URN)10.1136/sextrans-2018-053635 (DOI)000471868700012 ()30154157 (PubMedID)2-s2.0-85052888876 (Scopus ID)
Note

Funding Agencies:

Programa de Apoio a Pos-Graduacao (PROAP)  

Coordenacao de Aperfeicoamento de Pessoal de Nivel Superior (CAPES), Brasilia, DF, Brazil  

Örebro County Council Research Committee  

Foundation for Medical Research at Örebro University Hospital, Örebro, Sweden 

Available from: 2018-09-03 Created: 2018-09-03 Last updated: 2019-07-22Bibliographically approved
Rowley, J., Vander Hoorn, S., Korenromp, E., Low, N., Unemo, M., Abu-Raddad, L. J., . . . Taylor, M. M. (2019). Chlamydia, gonorrhoea, trichomoniasis and syphilis: global prevalence and incidence estimates, 2016. Bulletin of the World Health Organization, 97(8), 548-562P
Open this publication in new window or tab >>Chlamydia, gonorrhoea, trichomoniasis and syphilis: global prevalence and incidence estimates, 2016
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2019 (English)In: Bulletin of the World Health Organization, ISSN 0042-9686, E-ISSN 1564-0604, Vol. 97, no 8, p. 548-562PArticle in journal (Refereed) Published
Abstract [en]

Objective: To generate estimates of the global prevalence and incidence of urogenital infection with chlamydia, gonorrhoea, trichomoniasis and syphilis in women and men, aged 15-49 years, in 2016.

Methods: For chlamydia, gonorrhoea and trichomoniasis, we systematically searched for studies conducted between 2009 and 2016 reporting prevalence. We also consulted regional experts. To generate estimates, we used Bayesian meta-analysis. For syphilis, we aggregated the national estimates generated by using Spectrum-STI.

Findings: For chlamydia, gonorrhoea and/or trichomoniasis, 130 studies were eligible. For syphilis, the Spectrum-STI database contained 978 data points for the same period.The 2016 global prevalence estimates in women were: chlamydia 3.8% (95% uncertainty interval, UI: 33-4.5); gonorrhoea 0.9% (95% UI: 0.7-1.1); trichomoniasis 53% (95% UI:4.0-7.2); and syphilis 0.5% (95% UI: 0.4-0.6). In men prevalence estimates were: chlamydia 2.7% (95% UI: 1.9-3.7); gonorrhoea 0.7% (95% UI: 05-1.1); trichomoniasis 0.6% (95% UI: 0.4-0.9); and syphilis 05% (95% UI: 0.4-0.6). Total estimated incident cases were 376.4 million: 127.2 million (95% UI: 95.1-165.9 million) chlamydia cases; 86.9 million (95% UI: 58.6-123.4 million) gonorrhoea cases; 156.0 million (95% UI: 103.4-231.2 million) trichomoniasis cases; and 6.3 million (95% UI: 55-7.1 million) syphilis cases.

Conclusion: Global estimates of prevalence and incidence of these four curable sexually transmitted infections remain high. The study highlights the need to expand data collection efforts at country level and provides an initial baseline for monitoring progress of the World Health Organization global health sector strategy on sexually transmitted infections 2016-2021.

Place, publisher, year, edition, pages
World Health Organization, 2019
National Category
Public Health, Global Health, Social Medicine and Epidemiology Dermatology and Venereal Diseases
Identifiers
urn:nbn:se:oru:diva-75706 (URN)10.2471/BLT.18.228486 (DOI)000477948400015 ()31384073 (PubMedID)
Note

Funding Agencies:

U.S. Centers for Disease Control and Prevention  

United Kingdom Department for International Development  

World Health Organization Human Reproduction Programme  

Qatar National Research Fund  NPRP 9-040-3-008 

Available from: 2019-08-14 Created: 2019-08-14 Last updated: 2019-08-14Bibliographically approved
Lee, K., Nakayama, S.-I., Osawa, K., Yoshida, H., Arakawa, S., Furubayashi, K.-I., . . . Ohnishi, M. (2019). Clonal expansion and spread of the ceftriaxone-resistant Neisseria gonorrhoeae strain FC428, identified in Japan in 2015, and closely related isolates. Journal of Antimicrobial Chemotherapy, 74(7), 1812-1819
Open this publication in new window or tab >>Clonal expansion and spread of the ceftriaxone-resistant Neisseria gonorrhoeae strain FC428, identified in Japan in 2015, and closely related isolates
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2019 (English)In: Journal of Antimicrobial Chemotherapy, ISSN 0305-7453, E-ISSN 1460-2091, Vol. 74, no 7, p. 1812-1819Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: Ceftriaxone resistance in Neisseria gonorrhoeae is a major public health concern globally because a high-dose (1 g) injection of ceftriaxone is the only remaining option for empirical monotherapy of gonorrhoea. The ceftriaxone-resistant gonococcal strain FC428, cultured in Osaka in 2015, is suspected to have spread nationally and internationally. We describe the complete finished genomes of FC428 and two closely related isolates from Osaka in 2015, and examine the genomic epidemiology of these isolates plus three ceftriaxone-resistant gonococcal isolates from Osaka and Hyogo in 2016-17 and four ceftriaxone-resistant gonococcal isolates cultured in 2017 in Australia, Canada and Denmark.

METHODS: During 2015-17, we identified six ceftriaxone-resistant gonococcal isolates through our surveillance systems in Kyoto, Osaka and Hyogo. Antimicrobial susceptibility testing (six antimicrobials) was performed using Etest. Complete whole-genome sequences of the first three isolates (FC428, FC460 and FC498) from 2015 were obtained using PacBio RS II and Illumina MiSeq sequencing. The three complete genome sequences and draft genome sequences of the three additional Japanese (sequenced with Illumina MiSeq) and four international ceftriaxone-resistant isolates were compared.

RESULTS: Detailed genomic analysis suggested that the Japanese isolates (FC428, FC460, FC498, KU16054, KM383 and KU17039) and the four international MLST ST1903 isolates from Australia, Canada and Denmark formed four linked subclades.

CONCLUSIONS: Using detailed genomic analysis, we describe the clonal expansion of the ceftriaxone-resistant N. gonorrhoeae strain FC428, initially identified in 2015 in Japan, and closely related isolates. FC428 and its close relatives show some genomic diversity, suggesting multiple genetic subclades are already spreading internationally.

Place, publisher, year, edition, pages
Oxford University Press, 2019
National Category
Infectious Medicine
Identifiers
urn:nbn:se:oru:diva-73900 (URN)10.1093/jac/dkz129 (DOI)000474267600008 ()31002306 (PubMedID)2-s2.0-85068506219 (Scopus ID)
Note

Funding Agency:

Japan Agency for Medical Research and Development (AMED)  JP18fk0108062

Available from: 2019-04-24 Created: 2019-04-24 Last updated: 2019-08-08Bibliographically approved
Mercer, C. H., Clifton, S., Prior, G., Aldridge, R. W., Bonell, C., Copas, A. J., . . . Sonnenberg, P. (2019). Collecting and exploiting data to understand a nation's sexual health needs: Implications for the British National Surveys of Sexual Attitudes and Lifestyles (Natsal). Sexually Transmitted Infections, 95(3), 159-161
Open this publication in new window or tab >>Collecting and exploiting data to understand a nation's sexual health needs: Implications for the British National Surveys of Sexual Attitudes and Lifestyles (Natsal)
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2019 (English)In: Sexually Transmitted Infections, ISSN 1368-4973, E-ISSN 1472-3263, Vol. 95, no 3, p. 159-161Article in journal, Editorial material (Refereed) Published
Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2019
Keywords
Methodology, sexual behavior, sexual health, survey
National Category
Infectious Medicine
Identifiers
urn:nbn:se:oru:diva-74215 (URN)10.1136/sextrans-2018-053571 (DOI)000471870500001 ()30890634 (PubMedID)2-s2.0-85063136071 (Scopus ID)
Funder
Wellcome trust, 212931/Z/18/Z
Note

Funding Agencies:

Economic and Social Research Council  

National Institute of Health Research 

Available from: 2019-05-10 Created: 2019-05-10 Last updated: 2019-07-22Bibliographically approved
Lee, H., Suh, Y. H., Lee, S., Kim, Y.-K., Han, M.-S., Bae, H. G., . . . Lee, K. (2019). Emergence and Spread of Cephalosporin-Resistant Neisseria gonorrhoeae with Mosaic penA Alleles, South Korea, 2012-2017. Emerging Infectious Diseases, 25(3), 416-424
Open this publication in new window or tab >>Emergence and Spread of Cephalosporin-Resistant Neisseria gonorrhoeae with Mosaic penA Alleles, South Korea, 2012-2017
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2019 (English)In: Emerging Infectious Diseases, ISSN 1080-6040, E-ISSN 1080-6059, Vol. 25, no 3, p. 416-424Article in journal (Refereed) Published
Abstract [en]

In South Korea, surveillance of antimicrobial drug resistance in Neisseria gonorrhoeae is extremely limited. We describe the emergence and subsequent national spread of N. gonorrhoeae strains with mosaic penA alleles associated with decreased susceptibility and resistance to extended-spectrum cephalosporins. From 2012 through 2017, the proportion of mosaic penA alleles in gonococcal-positive nucleic acid amplification test (NAAT) specimens across South Korea increased from 1.1% to 23.9%. Gonococcal strains with mosaic penA alleles emerged in the international hubs of Seoul in Gyeonggi Province and Busan in South Gyeongsang Province and subsequently spread across South Korea. Most common was mosaic penA-10.001 (n = 572 isolates; 94.7%), which is associated with cefixime resistance. We also identified mosaic penA-34.001 and penA-60.001, both of which are associated with multidrug-resistant gonococcal strains and spread of cefixime and ceftriaxone resistance. Implementation of molecular resistance prediction from N. gonorrhoeae-positive nucleic acid amplification test specimens is imperative in South Korea and internationally.

Place, publisher, year, edition, pages
Centers for Disease Control and Prevention, 2019
National Category
Infectious Medicine Immunology in the medical area
Identifiers
urn:nbn:se:oru:diva-72974 (URN)10.3201/eid2503.181503 (DOI)000459021000003 ()30789143 (PubMedID)2-s2.0-85061958068 (Scopus ID)
Available from: 2019-03-07 Created: 2019-03-07 Last updated: 2019-03-07Bibliographically approved
Yéo, A., Kouamé-Blavo, B., Kouamé, C. E., Ouattara, A., Yao, A. C., Gbedé, B. D., . . . Unemo, M. (2019). Establishment of a Gonococcal Antimicrobial Surveillance Programme, in Accordance With World Health Organization Standards, in Côte d'Ivoire, Western Africa, 2014-2017. Sexually Transmitted Diseases, 46(3), 179-184
Open this publication in new window or tab >>Establishment of a Gonococcal Antimicrobial Surveillance Programme, in Accordance With World Health Organization Standards, in Côte d'Ivoire, Western Africa, 2014-2017
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2019 (English)In: Sexually Transmitted Diseases, ISSN 0148-5717, E-ISSN 1537-4521, Vol. 46, no 3, p. 179-184Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Antimicrobial resistance (AMR) in Neisseria gonorrhoeae is compromising the treatment of gonorrhea globally. Recent AMR data are extremely limited in Africa, and mainly totally lacking in Western Africa, including Côte d'Ivoire. This study (i) established a quality-assured gonococcal antimicrobial surveillance program, according to World Health Organization quality criteria, (ii) investigated the AMR to 8 therapeutic antimicrobials in gonococcal isolates from 2014 to 2017, and (iii) provided evidence for updating the National Sexually Transmitted Disease Syndromic Management Guidelines in Côte d'Ivoire.

METHODS: During 2014 to 2017, gonococcal isolates were obtained from sexually active symptomatic or asymptomatic males and females in 14 sites in Côte d'Ivoire. It was a special focus on symptomatic males, and their sexual partners, due to the higher culture positivity rates in symptomatic males. Patient metadata were collected, including age, gender, sexual orientation, and symptoms. Minimum inhibitory concentrations of 8 antimicrobials were determined by Etest and interpreted using European Committee on Antimicrobial Susceptibility Testing breakpoints. β-lactamase production was detected using cefinase disks.

RESULTS: The level of resistance, examining 212 gonococcal isolates, was as follows: 84.9% to tetracycline, 68.9% to benzylpenicillin, 62.7% to ciprofloxacin, 6.1% to azithromycin, and 1.4% to gentamicin. All isolates were susceptible to ceftriaxone, cefixime and spectinomycin.

CONCLUSIONS: We provide the first gonococcal AMR data, quality assured according to World Health Organization standards, from Côte d'Ivoire since more than 20 years. The high ciprofloxacin resistance, which informed a revision of the national syndromic management guideline during study, and relatively high resistance to azithromycin demand an improved gonococcal antimicrobial surveillance program and increased awareness when prescribing treatment in Côte d'Ivoire.

Place, publisher, year, edition, pages
Lippincott Williams & Wilkins, 2019
National Category
Infectious Medicine
Identifiers
urn:nbn:se:oru:diva-72899 (URN)10.1097/OLQ.0000000000000943 (DOI)000459593600010 ()30461598 (PubMedID)2-s2.0-85061281997 (Scopus ID)
Note

Funding Agencies:

Institut Pasteur de Cote d'Ivoire, Abidjan, Cote d'Ivoire  

Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland 

Available from: 2019-03-04 Created: 2019-03-04 Last updated: 2019-06-19Bibliographically approved
Unemo, M., Hansen, M., Hadad, R., Lindroth, Y., Fredlund, H., Puolakkainen, M. & Sundqvist, M. (2019). Finnish new variant of Chlamydia trachomatis escaping detection in the Aptima Combo 2 assay also present in Orebro County, Sweden, May 2019. Eurosurveillance, 24(26), 10-14, Article ID 1900370.
Open this publication in new window or tab >>Finnish new variant of Chlamydia trachomatis escaping detection in the Aptima Combo 2 assay also present in Orebro County, Sweden, May 2019
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2019 (English)In: Eurosurveillance, ISSN 1025-496X, E-ISSN 1560-7917, Vol. 24, no 26, p. 10-14, article id 1900370Article in journal (Refereed) Published
Abstract [en]

We identified the first two cases of the Finnish new variant of Chlamydia trachomatis (F-nvCT) beyond Finland in two clinical urogenital specimens in Orebro County, Sweden. These Aptima Combo 2 assay-negative specimens were Aptima Chlamydia trachomatis (CT) assay positive and had the characteristic C1515T mutation in the 23S rRNA gene. From 22 March to 31 May 2019, 1.3% (2/158) of the CT-positive cases in Orebro County were missed because of the F-nvCT. International awareness, investigations and actions are essential.

Place, publisher, year, edition, pages
European Centre for Disease Prevention and Control, 2019
National Category
Infectious Medicine
Identifiers
urn:nbn:se:oru:diva-75223 (URN)10.2807/1560-7917.ES.2019.24.26.1900370 (DOI)000473116300003 ()31266590 (PubMedID)
Available from: 2019-07-26 Created: 2019-07-26 Last updated: 2019-07-26Bibliographically approved
Gianecini, R. A., Golparian, D., Zittermann, S., Litvik, A., Gonzalez, S., Oviedo, C., . . . Galarza, P. (2019). Genome-based epidemiology and antimicrobial resistance determinants of Neisseria gonorrhoeae isolates with decreased susceptibility and resistance to extended-spectrum cephalosporins in Argentina in 2011-16. Journal of Antimicrobial Chemotherapy, 74(6), 1551-1559
Open this publication in new window or tab >>Genome-based epidemiology and antimicrobial resistance determinants of Neisseria gonorrhoeae isolates with decreased susceptibility and resistance to extended-spectrum cephalosporins in Argentina in 2011-16
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2019 (English)In: Journal of Antimicrobial Chemotherapy, ISSN 0305-7453, E-ISSN 1460-2091, Vol. 74, no 6, p. 1551-1559Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: Our aim was to describe the molecular epidemiology and antimicrobial resistance determinants of isolates of Neisseria gonorrhoeae with decreased susceptibility and resistance to extended-spectrum cephalosporins (ESCs) in Argentina in 2011-16.

METHODS: Gonococcal isolates (n = 158) with decreased susceptibility and resistance to ESCs collected in 2011-16 across Argentina were subjected to WGS and antimicrobial susceptibility testing for six antimicrobials.

RESULTS: In total, 50% of the isolates were resistant to cefixime, 1.9% were resistant to ceftriaxone, 37.3% were resistant to azithromycin and 63.9% of the isolates showed an MDR phenotype. Resistance and decreased susceptibility to ESCs was mainly associated with isolates possessing the mosaic penA-34.001, in combination with an mtrR promoter A deletion, and PorB1b amino acid substitutions G120K/A121N. Phylogenetic analysis revealed two main clades of circulating strains, which were associated with the N. gonorrhoeae multiantigen sequence typing (NG-MAST) ST1407 and closely related STs, and characterized by a high prevalence rate, wide geographical distribution and temporal persistence.

CONCLUSIONS: N. gonorrhoeae isolates with decreased susceptibility and resistance to ESCs in Argentina have emerged and rapidly spread mainly due to two clonal expansions after importation of one or two strains, which are associated with the international MDR NG-MAST ST1407 clone. The identification of the geographical dissemination and characteristics of these predominant clones may help to focus action plans and public health policies to control the spread of ESC resistance in Argentina. Dual antimicrobial therapy (ceftriaxone plus azithromycin) for gonorrhoea needs to be considered in Argentina.

Place, publisher, year, edition, pages
Oxford University Press, 2019
National Category
Infectious Medicine
Identifiers
urn:nbn:se:oru:diva-72874 (URN)10.1093/jac/dkz054 (DOI)30820563 (PubMedID)
Available from: 2019-03-04 Created: 2019-03-04 Last updated: 2019-06-04Bibliographically approved
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