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First National Genomic Epidemiological Study of Neisseria gonorrhoeae Strains Spreading Across Sweden in 2016
Örebro University, School of Medical Sciences. World Health Organization Collaborating Centre for Gonorrhoea and Other Sexually Transmitted Infections, National Reference Laboratory for Sexually Transmitted Infections, Department of Laboratory Medicine.
Örebro University, School of Medical Sciences. World Health Organization Collaborating Centre for Gonorrhoea and Other Sexually Transmitted Infections, National Reference Laboratory for Sexually Transmitted Infections, Department of Laboratory Medicine.ORCID iD: 0000-0002-0688-2521
Public Health Agency of Sweden, Solna, Sweden.
Department of Clinical Microbiology, Karolinska University Hospital, Huddinge, Sweden.
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2022 (English)In: Frontiers in Microbiology, E-ISSN 1664-302X, Vol. 12, article id 820998Article in journal (Refereed) Published
Abstract [en]

The increasing transmission and antimicrobial resistance (AMR) in Neisseria gonorrhoeae is a global health concern with worrying trends of decreasing susceptibility to also the last-line extended-spectrum cephalosporin (ESC) ceftriaxone. A dramatic increase of reported gonorrhea cases has been observed in Sweden from 2016 and onward. The aim of the present study was to comprehensively investigate the genomic epidemiology of all cultured N. gonorrhoeae isolates in Sweden during 2016, in conjunction with phenotypic AMR and clinical and epidemiological data of patients. In total, 1279 isolates were examined. Etest and whole-genome sequencing (WGS) were performed, and epidemiological data obtained from the Public Health Agency of Sweden. Overall, 51.1%, 1.7%, and 1.3% resistance to ciprofloxacin, cefixime, and azithromycin, respectively, was found. No isolates were resistant to ceftriaxone, however, 9.3% of isolates showed a decreased susceptibility to ceftriaxone and 10.5% to cefixime. In total, 44 penA alleles were found of which six were mosaic (n = 92). Using the typing schemes of MLST, NG-MAST, and NG-STAR; 133, 422, and 280 sequence types, respectively, and 93 NG-STAR clonal complexes were found. The phylogenomic analysis revealed two main lineages (A and B) with lineage A divided into two main sublineages (A1 and A2). Resistance and decreased susceptibility to ESCs and azithromycin and associated AMR determinants, such as mosaic penA and mosaic mtrD, were predominantly found in sublineage A2. Resistance to cefixime and azithromycin was more prevalent among heterosexuals and MSM, respectively, and both were predominantly spread through domestic transmission. Continuous surveillance of the spread and evolution of N. gonorrhoeae, including phenotypic AMR testing and WGS, is essential for enhanced knowledge regarding the dynamic evolution of N. gonorrhoeae and gonorrhea epidemiology.

Place, publisher, year, edition, pages
Frontiers Media S.A., 2022. Vol. 12, article id 820998
Keywords [en]
Neisseria gonorrhoeae, Sweden, antimicrobial resistance, molecular epidemiology, whole-genome sequencing
National Category
Infectious Medicine
Identifiers
URN: urn:nbn:se:oru:diva-97021DOI: 10.3389/fmicb.2021.820998ISI: 000748113700001PubMedID: 35095823Scopus ID: 2-s2.0-85123806366OAI: oai:DiVA.org:oru-97021DiVA, id: diva2:1633916
Note

Funding agencies:

Örebro County Council Research Committee, Örebro, Sweden

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

Available from: 2022-02-01 Created: 2022-02-01 Last updated: 2024-01-17Bibliographically approved
In thesis
1. Implementation of strategies for management and prevention of sexually transmitted infections with focus on Neisseria gonorrhoeae and Chlamydia trachomatis
Open this publication in new window or tab >>Implementation of strategies for management and prevention of sexually transmitted infections with focus on Neisseria gonorrhoeae and Chlamydia trachomatis
2022 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Sexually transmitted infections (STIs) are a public health issue of great importance worldwide, with effects on fertility and reproduction. Chlamydia trachomatis and Neisseria gonorrhoeae, causative agents of chlamydia and gonorrhoea, respectively, are the most common bacterial STIs with an estimated 127 million new global cases of chlamydia and 87 million new gonorrhoea cases. The continued emergence of antimicrobial resistance (AMR) in N. gonorrhoeae may in the future lead to an untreatable infection. Prevention of these infections and controlling the development of AMR rely on several strategies developed by the World Health Organization (WHO). This thesis aimed to implement several of these strategies, including supporting vaccine development for C. trachomatis and N. gonorrhoeae, evaluating molecular methods for detecting N. gonorrhoeae, predicting AMR and supporting surveillance of the spread and prevalence of AMR in N. gonorrhoeae. The present studies on a C. trachomatis recombinant vaccine antigen and the investigation of similarities of N. gonorrhoeae antigen amino acid sequences to the antigens included in the meningococcal vaccine 4CMenB contributed to the field of vaccine development for STIs. The assay SpeeDx ResistancePlus® GC performed well in detecting N. gonorrhoeae and predicting ciprofloxacin resistance and could be used in AMR surveillance and individualised treatment. In 2016, the first national genomic surveillance of all N. gonorrhoeae isolates in Sweden was performed. This national surveillance study included whole-genome sequencing combined with phenotypic AMR and epidemiological data, which provides valuable information on circulating strains, epidemiology and phylogeny. Greater knowledge of gonorrhoea and gonococcal AMR epidemiology could inform decisions on guidelines and prevention. It is essential to continue to implement WHO strategies at the national and global levels to prevent and control chlamydia and gonorrhoea infections.

Place, publisher, year, edition, pages
Örebro: Örebro University, 2022. p. 104
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 267
Keywords
Neisseria gonorrhoeae, epidemiology, whole-genome sequencing, antimicrobial resistance (AMR), Chlamydia trachomatis, vaccine, strategies, management and prevention
National Category
Other Basic Medicine
Identifiers
urn:nbn:se:oru:diva-98526 (URN)9789175294407 (ISBN)
Public defence
2022-06-17, Örebro universitet, Campus USÖ, hörsal C1, Södra Grev Rosengatan 32, Örebro, 09:00 (English)
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Available from: 2022-04-11 Created: 2022-04-11 Last updated: 2022-06-16Bibliographically approved

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Hadad, RonzaGolparian, DanielUnemo, Magnus

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