What are we missing? Data from the Gonorrhoea Undetected Resistance Laboratory Study (GURLS)

Area of Science:

• Microbiology
• Public Health
• Infectious Disease Surveillance

Background:

• Increasing antimicrobial resistance in Neisseria gonorrhoeae, particularly to ceftriaxone, poses a significant public health threat.
• A 2022 cluster of ceftriaxone-resistant N. gonorrhoeae linked to Asia-Pacific students in the UK highlighted potential for undetected transmission.

Purpose of the Study:

• To estimate the prevalence of undetected ceftriaxone-resistant N. gonorrhoeae in England.
• To assess the effectiveness of current surveillance in identifying resistant strains.

Main Methods:

• Utilized sexually transmitted infection surveillance and university data to identify high-risk populations and locations.
• Employed an N. gonorrhoeae penA real-time PCR assay to detect the common ceftriaxone-resistance mechanism (penA-60.001) in residual specimens from women aged 18-30.

Main Results:

• Of 661 confirmed N. gonorrhoeae specimens tested, one was positive for the penA-60.001 mutation, indicating ceftriaxone resistance.
• This positive case was from an already identified patient, meaning no new, undetected cases of ceftriaxone-resistant N. gonorrhoeae were identified.

Conclusions:

• Current UK Health Security Agency (UKHSA) enhanced surveillance adequately detects ceftriaxone-resistant N. gonorrhoeae in England.
• The penA PCR is valuable but needs expansion to encompass all resistance-conferring penA alleles to maintain gonorrhoea as a treatable infection.