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Australian Gonococcal Surveillance Programme Annual Report, 2023.

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Antimicrobial resistance in Neisseria gonorrhoeae remains a public health concern. In 2023, Australia saw a record number of high-level azithromycin-resistant isolates and increasing penicillin and ciprofloxacin resistance, particularly in remote areas, impacting treatment recommendations.

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Area of Science:

  • Microbiology
  • Infectious Diseases
  • Public Health Surveillance

Background:

  • The Australian Gonococcal Surveillance Programme (AGSP) has monitored antimicrobial resistance in *Neisseria gonorrhoeae* for over 40 years.
  • Gonorrhoea treatment guidelines in Australia primarily recommend dual therapy with ceftriaxone and azithromycin.
  • Surveillance data is crucial for understanding resistance patterns and informing treatment strategies.

Purpose of the Study:

  • To report the 2023 antimicrobial susceptibility patterns of *Neisseria gonorrhoeae* isolates in Australia.
  • To identify trends in resistance to key antibiotics used in gonorrhoea treatment.
  • To assess the impact of resistance on current treatment recommendations.

Main Methods:

  • Standardised *in vitro* antimicrobial susceptibility testing was performed on 10,105 *Neisseria gonorrhoeae* isolates.
  • Data was collected from public and private sectors across all Australian jurisdictions.
  • Minimum Inhibitory Concentration (MIC) values were used to define resistance and decreased susceptibility.

Main Results:

  • In 2023, 0.22% of isolates showed decreased susceptibility to ceftriaxone (MIC ≥ 0.125 mg/L).
  • Azithromycin resistance was 4.5%, with a record 27 isolates exhibiting high-level resistance (MIC ≥ 256 mg/L).
  • Penicillin resistance was 30.7% and ciprofloxacin resistance was 60.3%, with significant jurisdictional variations, including increased rates in remote Northern Territory and Western Australia.

Conclusions:

  • While ceftriaxone susceptibility remains high, azithromycin resistance, particularly high-level, is increasing.
  • Rising penicillin and ciprofloxacin resistance in specific regions necessitates a review of treatment guidelines.
  • Continued surveillance by the AGSP is vital for tracking gonococcal antimicrobial resistance and guiding public health interventions.