Genomic Epidemiology of Azithromycin-Nonsusceptible <i>Neisseria gonorrhoeae</i>, Argentina, 2005–2019
Ricardo Gianecini, Tomás Poklépovich, Daniel Golparian, Noelia Cuenca, Ezequiel Tuduri, Magnus Unemo, Josefina Campos, Patricia Galarza, Gonococcal Antimicrobial Susceptibility Surveillance Programme—Argentina1
Abstract
G onorrhea, caused by infection with the bacte- rium Neisseria gonorrhoeae, is the second most prevalent bacterial sexually transmitted infection (STI) globally (1,2). The World Health Organization (WHO) estimated that in 2016, a total of 86.9 million incident gonorrhea cases occurred among persons 15-49 years of age, including 13.8 million cases in the WHO Region of the Americas (1). Researchers have documented antimicrobial resistance (AMR) to all drugs used to treat gonorrhea (2,3). Ceftriaxone, an extended-spectrum cephalosporin, is the last option for fi rst-line empirical treatment, but the emergence of ceftriaxone resistance has raised concerns about future treatments (2,4). Consequently, WHO guidelines and national guidelines of many countries now recommend a combination of ceftriaxone (250 mg-1 g) and azithromycin (1-2 g) as fi rst-line treatment for uncomplicated gonorrhea (5,6). However, in 2016 Fifer et al. ( Two years later, a gonococcal strain with ceftriaxone resistance and high-level azithromycin resistance was isolated in Australia and England (8-10). In recent years, international reports of azithromycin-resistant N. gonorrhoeae have substantially increased The WHO Global Gonococcal Antimicrobial Surveillance Program showed that in 2016, a total of 48.4% of reporting countries had an >5% increase in rates of azithromycin resistance (3).