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Australian Gonococcal Surveillance Programme Annual Report, 2024.

Monica Lahra1, Siobhan Hurley2, Sebastiaan Van Hal3

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Antimicrobial resistance in Neisseria gonorrhoeae (NG) is increasing in Australia, with decreased susceptibility to ceftriaxone doubling in 2024. Extensively drug-resistant (XDR) strains are emerging, posing a significant threat to current gonorrhea treatments.

Keywords:
Neisseria gonorrhoeaeantimicrobial resistancedisease surveillancegonococcal infection

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Area of Science:

  • Public Health and Microbiology
  • Antimicrobial Resistance Surveillance
  • Sexually Transmitted Infections

Background:

  • The Australian Gonococcal Surveillance Programme (AGSP) has monitored antimicrobial resistance in Neisseria gonorrhoeae (NG) for over 40 years.
  • Current treatment guidelines recommend dual therapy with ceftriaxone and azithromycin for gonorrhea in Australia.
  • Emerging resistance patterns necessitate continuous surveillance to inform treatment strategies.

Purpose of the Study:

  • To report on the antimicrobial susceptibility of Neisseria gonorrhoeae isolates in Australia for 2024.
  • To identify trends in resistance, including decreased susceptibility to ceftriaxone and azithromycin resistance.
  • To characterize extensively drug-resistant (XDR) NG isolates and their potential origins.

Main Methods:

  • Standardized antimicrobial susceptibility testing of 10,702 NG isolates collected nationwide.
  • Genomic analysis of resistant isolates to identify specific resistance mechanisms and sequence types.
  • Data capture of susceptibility patterns by the National Neisseria Network (NNN) as part of the AGSP.

Main Results:

  • Decreased susceptibility to ceftriaxone (DS-CRO) increased to 0.51% in 2024, more than double the previous year, with the mosaic penA 60.001 allele identified in most DS-CRO isolates.
  • Azithromycin resistance remained stable at 4.6%, with 0.43% exhibiting high-level resistance.
  • Nine extensively drug-resistant (XDR) NG isolates were reported in 2024, belonging to sequence type 16406 and associated with travel in the Asia-Pacific region.

Conclusions:

  • The increasing detection of drug-resistant NG, including XDR strains, is a significant public health concern in Australia.
  • The emergence of resistance is linked to importation, spread, and local transmission, with travel playing a role.
  • Enhanced surveillance and the exploration of novel prevention strategies, such as the MenB-4C vaccine, are crucial for managing gonorrhea.