To Örebro University

OBJECTIVE: The prevalence of Neisseria gonorrhoeae NG-MAST genogroup G1407, associated with decreased susceptibility to extended-spectrum cephalosporins and fluoroquinolone resistance, has declined in Europe and it switched from circulating predominantly in men who have sex with men (MSM) in 2009-10 to heterosexuals in 2013. We hypothesized that changes to gonorrhoea treatment guidelines combined with differences in country-level consumption of cephalosporins and quinolones contributed to this shift.

METHODS: Linear regression was used to evaluate associations between changes in prevalence of G1407 from 2009-10 to 2013 and country-level consumption of quinolones and cephalosporins in 2011/12 in 20 European countries.

RESULTS: Whilst the prevalence of G1407 declined from 2009-10 to 2013 in the EU/EEA, its absolute prevalence increased by 10% or more in 3 countries. The national prevalence of G1407 in 2013 was positively associated with population-level general cephalosporin and quinolone consumption in the preceding two years. The association between the prevalence of G1407 and proportion of the national sample derived from MSM was non-significant in 2009-10 and negative in 2013.

CONCLUSIONS: Our results are broadly compatible with the hypothesis that changes in gonorrhoea therapy to the more efficacious ceftriaxone (plus azithromycin) from 2010-11 and onwards resulted in a reduced prevalence of the resistance associated-G1407 overall but in MSM in particular. High population-level consumption of quinolones and cephalosporins in certain countries then contributed to the selection of G1407 predominantly in heterosexuals in these countries.