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Town K, Bolt H, Croxford S, Cole M, Harris S, Field N, Hughes G. Neisseria gonorrhoeae molecular typing for understanding sexual networks and antimicrobial resistance transmission: A systematic review. J Infect 2018; 76:507-514. [PMID: 29698633 PMCID: PMC5999358 DOI: 10.1016/j.jinf.2018.02.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 02/11/2018] [Accepted: 02/19/2018] [Indexed: 11/19/2022]
Abstract
Combined molecular and epidemiological data can describe the spread of gonorrhoea. Sexual networks can be inferred from molecular clusters of infection. Gender and sexual orientation are commonly used to characterise these networks. Application of these data within gonorrhoea control interventions is limited. Future studies should focus on evaluating molecular typing data in practice.
Objectives Neisseria gonorrhoeae (NG) is a significant global public health concern due to rising diagnoses rates and antimicrobial resistance. Molecular combined with epidemiological data have been used to understand the distribution and spread of NG, as well as relationships between cases in sexual networks, but the public health value gained from these studies is unclear. We conducted a systematic review to examine how molecular epidemiological studies have informed understanding of sexual networks and NG transmission, and subsequent public health interventions. Methods Five research databases were systematically searched up to 31st March 2017 for studies that used sequence-based DNA typing methods, including whole genome sequencing, and linked molecular data to patient-level epidemiological data. Data were extracted and summarised to identify common themes. Results Of the 49 studies included, 82% used NG Multi-antigen Sequence Typing. Gender and sexual orientation were commonly used to characterise sexual networks that were inferred using molecular clusters; clusters predominantly of one patient group often contained a small number of isolates from other patient groups. Suggested public health applications included using these data to target interventions at specific populations, confirm outbreaks, and inform partner management, but these were mainly untested. Conclusions Combining molecular and epidemiological data has provided insight into sexual mixing patterns, and dissemination of NG, but few studies have applied these findings to design or evaluate public health interventions. Future studies should focus on the application of molecular epidemiology in public health practice to provide evidence for how to prevent and control NG.
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Affiliation(s)
- Katy Town
- National Institute for Health Research Health Protection Research Unit in Blood Borne and Sexually Transmitted Infections at University College London in partnership with Public Health England and in collaboration with the London School of Hygiene and Tropical Medicine, Mortimer Market Centre, Third Floor, Capper Street, London WC1E 6JB, UK; Centre for Molecular Epidemiology and Translational Research, Institute for Global Health, University College London, Mortimer Market Centre, Capper Street, London WC1E 6JB, UK.
| | - Hikaru Bolt
- HIV/STI Department, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Sara Croxford
- HIV/STI Department, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Michelle Cole
- Antimicrobial Resistance and Healthcare Associated Infections (AMRHAI) Reference Unit, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Simon Harris
- The Wellcome Trust Sanger Institute, Genome Campus, Cambridge CB10 1SA, UK
| | - Nigel Field
- Centre for Molecular Epidemiology and Translational Research, Institute for Global Health, University College London, Mortimer Market Centre, Capper Street, London WC1E 6JB, UK
| | - Gwenda Hughes
- National Institute for Health Research Health Protection Research Unit in Blood Borne and Sexually Transmitted Infections at University College London in partnership with Public Health England and in collaboration with the London School of Hygiene and Tropical Medicine, Mortimer Market Centre, Third Floor, Capper Street, London WC1E 6JB, UK; HIV/STI Department, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
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Stefanelli P, Carannante A, Bonanno CL, Cusini M, Ghisetti V, Mencacci A, Barbui AM, Prignano G, Vocale C, Vacca P. Molecular Characterization of Penicillinase-Producing Neisseria gonorrhoeae Isolated in Two Time Periods, 2003-2004 and 2014-2015, in Italy. Microb Drug Resist 2018; 24:621-626. [PMID: 29293395 DOI: 10.1089/mdr.2017.0218] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The emergence of antibiotic resistant strains poses a great concern for gonorrhea treatment. The aim of this study was to characterize penicillinase-producing Neisseria gonorrhoeae (PPNG) isolates collected in Italy in two time frames, 2003-2004 and 2014-2015. A total of 80 PPNG were characterized for the blaTEM gene variant and the plasmid type. Furthermore, gonococci were typed using Neisseria gonorrhoeae multiantigen sequence typing. Antibiotic susceptibility assay was performed for penicillin, ciprofloxacin, ceftriaxone, and spectinomycin by Etest and minimum inhibitory concentration (MIC) test strip methods. The β-lactamase production was detected using nitrocefin test. Among PPNG isolates, four blaTEM alleles were identified as follows: blaTEM-1, blaTEM-228, blaTEMP14S, and blaTEM-135. The African plasmid possessed the blaTEM-1, blaTEM-228, and blaTEMP14S, whereas blaTEM-135 was identified in Toronto/Rio and Asian plasmids. The percentage of isolates with the blaTEM-1-carrying African plasmid increased from 42.5% in 2003-2004 to 55% in 2014-2015; conversely, the isolates with blaTEM-135-carrying Toronto/Rio plasmid decreased from 57.5% to 35%. Among the isolates carrying the Toronto/Rio plasmids possessing blaTEM-135, sequence type (ST)661 and ST5624 were found to be the predominant STs in both periods 2003-2004 and 2014-2015, respectively. More than half of the PPNG isolates were resistant to ciprofloxacin. Increase in the isolates carrying the African plasmid possessing blaTEM-1 and a parallel decrease of the blaTEM-135-carrying Toronto/Rio plasmid was observed. Moreover, PPNG isolate harbored Toronto/Rio plasmid with blaTEM-135 belonged mainly to two major STs (ST661 and ST5624). Given the possible role of a mutated blaTEM gene as an additional mechanism to extended spectrum β-lactamase resistance, it is crucial to monitor gonococci carrying these resistance genes.
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Affiliation(s)
- Paola Stefanelli
- 1 Department of Infectious Diseases, Istituto Superiore di Sanità , Rome, Italy
| | - Anna Carannante
- 1 Department of Infectious Diseases, Istituto Superiore di Sanità , Rome, Italy
| | | | - Marco Cusini
- 3 Foundation IRCCS Ca'Granda Ospedale Maggiore Policlinico Milano , Milan, Italy
| | - Valeria Ghisetti
- 4 Laboratory of Microbiology and Virology, Amedeo di Savoia Hospital , Turin, Italy
| | - Antonella Mencacci
- 5 Microbiology Section, Department of Experimental Medicine, University of Perugia , Perugia, Italy
| | - Anna Maria Barbui
- 6 Laboratory of Microbiology and Virology, Molinette Hospital , Turin, Italy
| | | | - Caterina Vocale
- 8 Unit of Clinical Microbiology, CRREM Laboratory, St. Orsola-Malpighi , University Hospital, Bologna, Italy
| | - Paola Vacca
- 1 Department of Infectious Diseases, Istituto Superiore di Sanità , Rome, Italy
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Carannante A, Renna G, Dal Conte I, Ghisetti V, Matteelli A, Prignano G, Impara G, Cusini M, D'Antuono A, Vocale C, Antonetti R, Gaino M, Busetti M, Latino MA, Mencacci A, Bonanno C, Cava MC, Giraldi C, Stefanelli P. Changing antimicrobial resistance profiles among Neisseria gonorrhoeae isolates in Italy, 2003 to 2012. Antimicrob Agents Chemother 2014; 58:5871-6. [PMID: 25070110 PMCID: PMC4187924 DOI: 10.1128/aac.00103-14] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Accepted: 07/03/2014] [Indexed: 02/05/2023] Open
Abstract
The emergence of Neisseria gonorrhoeae isolates displaying resistance to antimicrobial agents is a major public health concern and a serious issue related to the occurrence of further untreatable gonorrhea infections. A retrospective analysis on 1,430 N. gonorrhoeae isolates, collected from 2003 through 2012, for antimicrobial susceptibility by Etest and molecular characterization by Neisseria gonorrhoeae multiantigen sequence typing (NG-MAST) was carried out in Italy. Azithromycin-resistant gonococci decreased from 14% in 2007 to 2.2% in 2012. Similarly, isolates with high MICs to cefixime (>0.125 mg/liter) decreased from 11% in 2008 to 3.3% in 2012. The ciprofloxacin resistance rate remains quite stable, following an increasing trend up to 64% in 2012. The percentage of penicillinase-producing N. gonorrhoeae (PPNG) significantly declined from 77% in 2003 to 7% in 2012. A total of 81 multidrug-resistant (MDR) gonococci were identified, showing 11 different antimicrobial resistance patterns. These were isolated from men who have sex with men (MSM) and from heterosexual patients. Two sequence types (STs), ST661 and ST1407, were the most common. Genogroup 1407, which included cefixime-, ciprofloxacin-, and azithromycin-resistant isolates, was found. In conclusion, a change in the antimicrobial resistance profiles among gonococci was identified in Italy together with a percentage of MDR isolates.
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Affiliation(s)
- Anna Carannante
- Department of Infectious, Parasitic and Immune-mediated Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Giovanna Renna
- Department of Infectious, Parasitic and Immune-mediated Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Ivano Dal Conte
- STI Clinic, Department of Infectious Diseases, Amedeo di Savoia Hospital, Turin, Italy
| | - Valeria Ghisetti
- Microbiology and Virology Laboratory, Department of Infectious Diseases, Amedeo di Savoia Hospital, Turin, Italy
| | - Alberto Matteelli
- Institute of Infectious and Tropical Diseases, University of Brescia, Brescia, Italy
| | | | | | - Marco Cusini
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Antonietta D'Antuono
- Azienda Ospedaliero-Universitaria di Bologna Policlinico S. Orsola-Malpighi Unit of Dermatology, STDs Center, Bologna, Italy
| | - Caterina Vocale
- Unit of Clinical Microbiology, CRREM Laboratory, St. Orsola-Malpighi, University Hospital, Bologna, Italy
| | - Raffaele Antonetti
- Department of Clinical Pathology, Azienda Ospedaliero-Universitaria OORR, Foggia, Italy
| | - Marina Gaino
- Microbiology and Virology Laboratory, Santa Chiara Hospital, Trento, Italy
| | - Marina Busetti
- Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
| | - Maria Agnese Latino
- Laboratorio di Batteriologia, Ospedale Ostetrico Ginecologico Sant'Anna, Turin, Italy
| | - Antonella Mencacci
- Microbiology Section, Department of Experimental Medicine and Biochemical Sciences, University of Perugia, Perugia, Italy
| | - Carmen Bonanno
- Microbiology and Virology Laboratory, Sandro Pertini Hospital, Rome, Italy
| | - Maria Carmela Cava
- Microbiology and Virology Laboratory, Sandro Pertini Hospital, Rome, Italy
| | - Cristina Giraldi
- Microbiology and Virology Laboratory, Molecular Clinic, PO Annunziata Azienda Ospedaliera di Cosenza, Cosenza, Italy
| | - Paola Stefanelli
- Department of Infectious, Parasitic and Immune-mediated Diseases, Istituto Superiore di Sanità, Rome, Italy
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Chanal J, Lassau F, Morand P, Janier M, Dupin N. [What's new in the diagnosis and treatment of Neisseria gonorrhoeae]. Presse Med 2013; 42:454-8. [PMID: 23433914 DOI: 10.1016/j.lpm.2012.09.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2012] [Revised: 09/17/2012] [Accepted: 09/21/2012] [Indexed: 11/16/2022] Open
Abstract
Bacterial culture remains the gold standard for symptomatic infection. Nucleic Acid Amplification Tests (NAATs) have better sensitivity and specificity for rectal and pharyngeal specimens. A bacterial culture with antibiogram must be done for all NAAT positive specimens in order to modify antibiotics prescription if needed. We must fear a diffusion of extensively drug-resistant Neisseria gonorrhoeae in the future. Nevertheless, ceftriaxone 500 mg intramuscular with 1 g of azithromycin against Chlamydia trachomatis remains the treatment of N. gonorrhoeae infections. Screening of partners of identified cases and other STDs is the main measure to add to the treatment of gonorrhea.
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Affiliation(s)
- Johan Chanal
- Assistance publique-Hôpitaux de Paris, université Paris-5, hôpital Cochin, service de dermatologie, Paris, France.
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