WHO global antimicrobial resistance surveillance for Neisseria gonorrhoeae 2017–18: a retrospective observational study

Unemo, Magnus; Lahra, Monica M; Escher, Martina; Eremin, Sergey; Cole, Michelle J; Galarza, Patricia; Ndowa, Francis; Martin, Irene; Dillon, Jo-Anne R; Galas, Marcelo; Ramon-Pardo, Pilar; Weinstock, Hillard; Wi, Teodora

doi:10.1016/s2666-5247(21)00171-3

Cited by 272Reproductive tract infections researchAntibiotic Use and ResistanceAntibiotic Resistance in Bacteria

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WHO global antimicrobial resistance surveillance for Neisseria gonorrhoeae 2017–18: a retrospective observational study

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Unemo, Magnus, Lahra, Monica M, Escher, Martina, Eremin, Sergey, Cole, Michelle J, Galarza, Patricia, Ndowa, Francis, Martin, Irene, Dillon, Jo-Anne R, Galas, Marcelo, Ramon-Pardo, Pilar, Weinstock, Hillard, Wi, Teodora·2021·The Lancet Microbe

DOI 10.1016/s2666-5247(21)00171-3

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Abstract

BACKGROUND: Gonorrhoea and antimicrobial resistance (AMR) in Neisseria gonorrhoeae are major health concerns globally. Increased global surveillance of gonococcal AMR is essential. We aimed to describe the 2017-18 data from WHO's global gonococcal AMR surveillance, and to discuss priorities essential for the effective management and control of gonorrhoea. METHODS: We did a retrospective observational study of the AMR data of gonococcal isolates reported to WHO by 73 countries in 2017-18. WHO recommends that each country collects at least 100 gonococcal isolates per year, and that quantitative methods to determine the minimum inhibitory concentration of antimicrobials, interpreted by internationally standardised resistance breakpoints, are used. FINDINGS: In 2017-18, 73 countries provided AMR data for one or more drug. Decreased susceptibility or resistance to ceftriaxone was reported by 21 (31%) of 68 reporting countries and to cefixime by 24 (47%) of 51 reporting countries. Resistance to azithromycin was reported by 51 (84%) of 61 reporting countries and to ciprofloxacin by all 70 (100%) reporting countries. The annual proportion of decreased susceptibility or resistance across countries was 0-21% to ceftriaxone and 0-22% to cefixime, and that of resistance was 0-60% to azithromycin and 0-100% to ciprofloxacin. The number of countries reporting gonococcal AMR and resistant isolates, and the number of examined isolates, have increased since 2015-16. Surveillance remains scarce in central America and the Caribbean and eastern Europe, and in the WHO African, Eastern Mediterranean, and South-East Asian regions. INTERPRETATION: In many countries, ciprofloxacin resistance was exceedingly high, azithromycin resistance was increasing, and decreased susceptibility or resistance to ceftriaxone and cefixime continued to emerge. WHO's global surveillance of gonococcal AMR needs to expand internationally to provide imperative data for national and international management guidelines and public health policies. Improved prevention, early diagnosis, treatment of index patients and partners, enhanced surveillance (eg, infection, AMR, treatment failures, and antimicrobial use or misuse), and increased knowledge on antimicrobial selection, stewardship, and pharmacokinetics or pharmacodynamics are essential. The development of rapid, accurate, and affordable point-of-care gonococcal diagnostic tests, new antimicrobials, and gonococcal vaccines is imperative. FUNDING: None.

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Antimicrobial resistance in N. gonorrhoeae has emerged for all medicines used for empirical first-line treatment.
“Antimicrobial resistance in N. gonorrhoeae has emerged for all medicines used for empirical first-line treatment.”
From Updated recommendations for the treatment of Neisseria gonorrhoeae, Chlamydia trachomatis, and Treponema pallidum (syphilis) and new recommendations on syphilis testing and partner services (2024) · cites this paper as [9]
In 2019-2020, 20 out of 59 countries (34%) reported isolates with reduced susceptibility or resistance to ceftriaxone.
“In 2019–2020, 20 out of 59 countries (34%) reported isolates with reduced susceptibility or resistance to ceftriaxone”
From Updated recommendations for the treatment of Neisseria gonorrhoeae, Chlamydia trachomatis, and Treponema pallidum (syphilis) and new recommendations on syphilis testing and partner services (2024) · cites this paper as [9]
In 2019-2020, resistance to ciprofloxacin was reported by all 58 reporting countries (100%).
“resistance to ciprofloxacin was reported by all 58 reporting countries (100%”
From Updated recommendations for the treatment of Neisseria gonorrhoeae, Chlamydia trachomatis, and Treponema pallidum (syphilis) and new recommendations on syphilis testing and partner services (2024) · cites this paper as [9]
In 2019-2020, 11 of 41 countries (27%) reported reduced susceptibility or resistance to cefixime.
“11 of 41 countries (27%) reported reduced susceptibility or resistance to cefixime”
From Updated recommendations for the treatment of Neisseria gonorrhoeae, Chlamydia trachomatis, and Treponema pallidum (syphilis) and new recommendations on syphilis testing and partner services (2024) · cites this paper as [9]
In 2019-2020, isolates with resistance to azithromycin were reported by 42 of 47 countries (89%).
“Isolates with resistance to azithromycin were reported by 42 of 47 countries (89%”
From Updated recommendations for the treatment of Neisseria gonorrhoeae, Chlamydia trachomatis, and Treponema pallidum (syphilis) and new recommendations on syphilis testing and partner services (2024) · cites this paper as [9]

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Insight into Prevention of Neisseria Gonorrhoeae: A Short Review
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WHO global gonococcal antimicrobial surveillance programmes, 2019–22: a retrospective observational study
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Self-citation

Authors: Unemo, M., Lahra, M. M., Escher, M., Eremin, S., Cole, M. J., Galarza, P., Ndowa, F., Martin, I., Dillon, J.-A. R., Galas, M., Ramon-Pardo, P., Weinstock, H., & Wi, T.
Affiliations: Örebro University (SE)
NSW Health Pathology (AU)
World Health Organization (CH)
Public Health England (GB)
Administración Nacional de Laboratorios e Institutos de Salud (AR)
University of Saskatchewan (CA)
World Health Organization Regional Office for the Americas (US)
Centers for Disease Control and Prevention (US)
Corresponding author: Unemo, Magnus
ORCID: Unemo, Magnus
Lahra, Monica M
Eremin, Sergey
Cole, Michelle J
Galarza, Patricia
Ndowa, Francis
Dillon, Jo-Anne R
Wi, Teodora
Venue: The Lancet Microbe
Publisher: Elsevier BV
Published: 2021-11
Volume: 2
Issue: 11
Pages: e627-e636
ISSN: 2666-5247 (ISSN-L)
DOI: 10.1016/s2666-5247(21)00171-3
OpenAlex: W3197926693
Cited by: 272
References: 27
Citations by year: 2026: 41 · 2025: 55 · 2024: 73 · 2023: 66 · 2022: 35 · 2021: 2
FWCI: 31.05
Type: journal article
Language: en
Open access: gold
doi.org
Licence: cc-by
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/legal/tdmrep-license (tdm)
creativecommons.org/licenses/by/4.0/ (vor)
Locations: The Lancet Microbe (publishedVersion, cc-by)
PubMed (publishedVersion)
DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders: World Health Organization
Topics: Life Sciences › Immunology and Microbiology › Microbiology › Reproductive tract infections research
Health Sciences › Medicine › Infectious Diseases › Antibiotic Use and Resistance
Health Sciences › Medicine › Microbiology (medical) › Antibiotic Resistance in Bacteria
Keywords: resistance, Neisseria gonorrhoeae, gonorrhea, global surveillance, ciprofloxacin resistance, azithromycin resistance, ceftriaxone resistance, cefixime resistance, resistance breakpoints, minimum inhibitory concentration, surveillance coverage, antimicrobial susceptibility trends, infection control, partner notification, public health policy
MeSH terms: Anti-Bacterial Agents, Ceftriaxone, Ciprofloxacin, Gonorrhea, Humans, Neisseria gonorrhoeae, World Health Organization, Azithromycin, Cefixime, Drug Resistance, Bacterial

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WHO global antimicrobial resistance surveillance for Neisseria gonorrhoeae 2017–18: a retrospective observational study

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