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Gao H, Liu Q, Wang X, Li T, Li H, Li G, Tan L, Chen Y. Deciphering the role of female reproductive tract microbiome in reproductive health: a review. Front Cell Infect Microbiol 2024; 14:1351540. [PMID: 38562966 PMCID: PMC10982509 DOI: 10.3389/fcimb.2024.1351540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 03/08/2024] [Indexed: 04/04/2024] Open
Abstract
Relevant studies increasingly indicate that female reproductive health is confronted with substantial challenges. Emerging research has revealed that the microbiome interacts with the anatomy, histology, and immunity of the female reproductive tract, which are the cornerstone of maintaining female reproductive health and preventing adverse pregnancy outcomes. Currently, the precise mechanisms underlying their interaction and impact on physiological functions of the reproductive tract remain elusive, constituting a prominent area of investigation within the field of female reproductive tract microecology. From this new perspective, we explore the mechanisms of interactions between the microbiome and the anatomy, histology, and immunity of the female reproductive tract, factors that affect the composition of the microbiome in the female reproductive tract, as well as personalized medicine approaches in managing female reproductive tract health based on the microbiome. This study highlights the pivotal role of the female reproductive tract microbiome in maintaining reproductive health and influencing the occurrence of reproductive tract diseases. These findings support the exploration of innovative approaches for the prevention, monitoring and treatment of female reproductive tract diseases based on the microbiome.
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Affiliation(s)
- Hong Gao
- Nursing Department, The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, China
- Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON, Canada
| | - Qiao Liu
- School of Nursing, University of South China, Hengyang, China
| | - Xiaolan Wang
- Center for a Combination of Obstetrics and Gynecology and Reproductive Medicine, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, China
| | - Ting Li
- Department of Obstetrics, The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, China
| | - Huanhuan Li
- Department of Gynaecology, The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, China
| | - Genlin Li
- Center for a Combination of Obstetrics and Gynecology and Reproductive Medicine, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, China
| | - Lingling Tan
- Nursing Department, The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, China
| | - Yahui Chen
- School of Nursing, University of South China, Hengyang, China
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Kittiyaowamarn R, Girdthep N, Cherdtrakulkiat T, Sangprasert P, Tongtoyai J, Weston E, Borisov A, Dunne EF, Chinhiran K, Woodring J, Ngarmjiratam N, Masciotra S, Frankson R, Sirivongrangson P, Unemo M, Wi T. Neisseria gonorrhoeae antimicrobial susceptibility trends in Bangkok, Thailand, 2015-21: Enhanced Gonococcal Antimicrobial Surveillance Programme (EGASP). JAC Antimicrob Resist 2023; 5:dlad139. [PMID: 38115859 PMCID: PMC10729850 DOI: 10.1093/jacamr/dlad139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 12/01/2023] [Indexed: 12/21/2023] Open
Abstract
Objectives Rising antimicrobial resistance (AMR) in Neisseria gonorrhoeae is a global public health concern. Many ceftriaxone-resistant cases have been linked to Asia. In the WHO/CDC global Enhanced Gonococcal Antimicrobial Surveillance Programme (EGASP), we conducted AMR surveillance at two clinical sites in Bangkok, Thailand, 2015-21. Methods Urethral discharge samples, from males with urethral discharge and/or dysuria, were Gram-stained and cultured. ETEST was performed to determine AMR. EGASP MIC alert values, CLSI and EUCAST breakpoints were used. Results In 2015-21, gonococcal isolates were cultured from 1928 cases; most (64.1%) were males reporting having sex with females. The sensitivity and specificity of Gram-stained microscopy compared with culture for detection of gonococci were 97.5% and 96.6%, respectively. From 2015 to 2021, the azithromycin MIC90 increased from 0.125 to 1 mg/L, and the MIC90 of ceftriaxone and cefixime increased from 0.008 and ≤0.016 mg/L to 0.032 and 0.064 mg/L, respectively. Eight EGASP MIC alert values (in seven isolates) were identified. Five alert values were for cefixime (all resistant according to EUCAST breakpoints) and three for azithromycin (all resistant according to EUCAST breakpoints). The average annual resistance to ciprofloxacin during 2015-21 was 92%. Conclusions A continuous high susceptibility to ceftriaxone, Thailand's first-line gonorrhoea treatment, was found. However, the increasing MICs of ceftriaxone, cefixime and azithromycin are a substantial threat, especially considering these are the last remaining options for the treatment of gonorrhoea. To monitor AMR, continuous and quality-assured gonococcal AMR surveillance such as the Thai WHO/CDC EGASP, ideally including WGS, is imperative globally.
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Affiliation(s)
- Rossaphorn Kittiyaowamarn
- Bangrak STIs Center, Division of AIDS and STIs, Department of Disease Control and Prevention, Thailand Ministry of Public Health, Nonthaburi, Thailand
| | - Natnaree Girdthep
- Bangrak STIs Center, Division of AIDS and STIs, Department of Disease Control and Prevention, Thailand Ministry of Public Health, Nonthaburi, Thailand
| | - Thitima Cherdtrakulkiat
- Division of HIV Prevention, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
- Division of HIV Prevention, Thailand Ministry of Public Health—U.S. Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | - Pongsathorn Sangprasert
- Bangrak STIs Center, Division of AIDS and STIs, Department of Disease Control and Prevention, Thailand Ministry of Public Health, Nonthaburi, Thailand
| | - Jaray Tongtoyai
- Division of HIV Prevention, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
- Division of HIV Prevention, Thailand Ministry of Public Health—U.S. Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | - Emily Weston
- Division of STD Prevention, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Andrey Borisov
- Division of HIV Prevention, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
- Division of HIV Prevention, Thailand Ministry of Public Health—U.S. Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | - Eileen F Dunne
- Division of HIV Prevention, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
- Division of HIV Prevention, Thailand Ministry of Public Health—U.S. Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | - Kittipoom Chinhiran
- Bangrak STIs Center, Division of AIDS and STIs, Department of Disease Control and Prevention, Thailand Ministry of Public Health, Nonthaburi, Thailand
| | - Joseph Woodring
- Division of HIV Prevention, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
- Division of HIV Prevention, Thailand Ministry of Public Health—U.S. Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | - Nattapon Ngarmjiratam
- Bangrak STIs Center, Division of AIDS and STIs, Department of Disease Control and Prevention, Thailand Ministry of Public Health, Nonthaburi, Thailand
| | - Silvina Masciotra
- Division of HIV Prevention, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
- Division of HIV Prevention, Thailand Ministry of Public Health—U.S. Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | - Rebekah Frankson
- Division of STD Prevention, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Pachara Sirivongrangson
- Department of Disease Control and Prevention, Thailand Ministry of Public Health, Nonthaburi, Thailand
| | - Magnus Unemo
- WHO Collaborating Centre for Gonorrhoea and Other STIs, Department of Laboratory Medicine, Microbiology, Örebro University, Örebro, Sweden
- Institute for Global Health, University College London, London, UK
| | - Teodora Wi
- Department of Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
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Sandoval MM, Bardach A, Rojas-Roque C, Alconada T, Gomez JA, Pinto T, Palermo C, Ciapponi A. Antimicrobial resistance of Neisseria gonorrhoeae in Latin American countries: a systematic review. J Antimicrob Chemother 2023; 78:1322-1336. [PMID: 37192385 PMCID: PMC10232280 DOI: 10.1093/jac/dkad071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 02/23/2023] [Indexed: 05/18/2023] Open
Abstract
BACKGROUND Detailed information is needed on the dynamic pattern of antimicrobial resistance (AMR) in Neisseria gonorrhoeae in Latin America and the Caribbean (LAC). OBJECTIVES To conduct a systematic review of AMR in N. gonorrhoeae in LAC. METHODS Electronic searches without language restrictions were conducted in PubMed, Embase, Cochrane Library, EconLIT, Cumulative Index of Nursing and Allied Health Literature, Centre for Reviews and Dissemination, and Latin American and Caribbean Literature in Health Sciences. Studies were eligible if published between 1 January 2011 and 13 February 2021, conducted in any LAC country (regardless of age, sex and population) and measured frequency and/or patterns of AMR to any antimicrobial in N. gonorrhoeae. The WHO Global Gonococcal Antimicrobial Surveillance Programme (WHO-GASP) for LAC countries and Latin American AMR SurveillanceNetwork databases were searched. AMR study quality was evaluated according to WHO recommendations. RESULTS AMR data for 38, 417 isolates collected in 1990-2018 were included from 31 publications, reporting data from Argentina, Brazil, Colombia, Peru, Uruguay, Venezuela and WHO-GASP. Resistance to extended-spectrum cephalosporins was infrequent (0.09%-8.5%). Resistance to azithromycin was up to 32% in the published studies and up to 61% in WHO-GASP. Resistance to penicillin, tetracycline and ciprofloxacin was high (17.6%-98%, 20.7%-90% and 5.9%-89%, respectively). Resistance to gentamicin was not reported, and resistance to spectinomycin was reported in one study. CONCLUSIONS This review provides data on resistance to azithromycin, potentially important given its use as first-line empirical treatment, and indicates the need for improved surveillance of gonococcal AMR in LAC. Trial registration: Registered in PROSPERO, CRD42021253342.
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Affiliation(s)
| | - Ariel Bardach
- Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Buenos Aires, Argentina
- Centro de Investigaciones Epidemiológicas y Salud Pública (CIESP-IECS), CONICET, Buenos Aires, Argentina
| | - Carlos Rojas-Roque
- Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Buenos Aires, Argentina
| | - Tomás Alconada
- Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Buenos Aires, Argentina
| | | | | | - Carolina Palermo
- Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Buenos Aires, Argentina
| | - Agustin Ciapponi
- Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Buenos Aires, Argentina
- Centro de Investigaciones Epidemiológicas y Salud Pública (CIESP-IECS), CONICET, Buenos Aires, Argentina
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Rowlinson E, Soge OO, Hughes JP, Berzkalns A, Thibault C, Kerani RP, Khosropour CM, Manhart LE, Golden MR, Barbee LA. Prior Exposure to Azithromycin and Azithromycin Resistance Among Persons Diagnosed With Neisseria gonorrhoeae Infection at a Sexual Health Clinic: 2012-2019. Clin Infect Dis 2023; 76:e1270-e1276. [PMID: 36001447 PMCID: PMC10169409 DOI: 10.1093/cid/ciac682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 08/11/2022] [Accepted: 08/19/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND There is conflicting evidence on whether prior azithromycin (AZM) exposure is associated with reduced susceptibility to AZM (AZMRS) among persons infected with Neisseria gonorrhoeae (NG). METHODS The study population included Public Health-Seattle and King County Sexual Health Clinic (SHC) patients with culture-positive NG infection at ≥1 anatomic site whose isolates were tested for AZM susceptibility in 2012-2019. We used multivariate logistic regression to examine the association of time since last AZM prescription from the SHC in ≤12 months with subsequent diagnosis with AZMRS NG (minimum inhibitory concentration [MIC], ≥2.0 µg/mL) and used linear regression to assess the association between the number of AZM prescriptions in ≤12 months and AZM MIC level, controlling for demographic, behavioral, and clinical characteristics. RESULTS A total of 2155 unique patients had 2828 incident NG infections, 156 (6%) of which were caused by AZMRS NG. AZMRS NG was strongly associated with receipt of AZM from the SHC in the prior 29 days (adjusted odds ratio, 6.76; 95% confidence interval [CI], 1.76 to 25.90) but not with receipt of AZM in the prior 30-365 days. Log AZM MIC level was not associated with the number of AZM prescriptions within ≤12 months (adjusted correlation, 0.0004; 95% CI, -.04 to .037) but was associated with number of prescriptions within <30 days (adjusted coefficient, 0.56; 95% CI, .13 to .98). CONCLUSIONS Recent individual-level AZM treatment is associated with subsequent AZMRS gonococcal infections. The long half-life and persistence of subtherapeutic levels of AZM may result in selection of resistant NG strains in persons with recent AZM use.
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Affiliation(s)
- Emily Rowlinson
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Olusegun O Soge
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington, USA
- Neisseria Reference Laboratory, University of Washington, Seattle, Washington, USA
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - James P Hughes
- Department of Biostatistics, University of Washington, Seattle, Washington, USA
| | - Anna Berzkalns
- HIV/STD Program, Public Health–Seattle and King County, Seattle, Washington, USA
| | - Christina Thibault
- HIV/STD Program, Public Health–Seattle and King County, Seattle, Washington, USA
| | - Roxanne P Kerani
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
- HIV/STD Program, Public Health–Seattle and King County, Seattle, Washington, USA
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | | | - Lisa E Manhart
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Matthew R Golden
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington, USA
- HIV/STD Program, Public Health–Seattle and King County, Seattle, Washington, USA
| | - Lindley A Barbee
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington, USA
- HIV/STD Program, Public Health–Seattle and King County, Seattle, Washington, USA
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Kandinov I, Shaskolskiy B, Kravtsov D, Vinokurova A, Gorshkova S, Kubanov A, Solomka V, Shagabieva J, Deryabin D, Dementieva E, Gryadunov D. Azithromycin Susceptibility Testing and Molecular Investigation of Neisseria gonorrhoeae Isolates Collected in Russia, 2020-2021. Antibiotics (Basel) 2023; 12:antibiotics12010170. [PMID: 36671371 PMCID: PMC9854565 DOI: 10.3390/antibiotics12010170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 01/11/2023] [Accepted: 01/12/2023] [Indexed: 01/17/2023] Open
Abstract
The aim of this work was to study the resistance to macrolides (azithromycin) in the modern Russian population of N. gonorrhoeae with the analysis of genetic resistance determinants. Azithromycin is not used to treat gonococcal infection in Russia. However, among 162 isolates collected in 2020-2021, 22 isolates (13.6%) were phenotypically resistant to azithromycin. Mutations in 23S rRNA genes were found only in two isolates; erm and mefA genes were absent. Azithromycin resistance was shown to be predominantly associated with mutations in the mtrR and mtrD genes of the MtrCDE efflux pump and their mosaic alleles which may have formed due to a horizontal transfer from N. meningitidis. A total of 30 types of mtrR alleles and 10 types of mtrD alleles were identified including mosaic variants. Matching between the mtrR and mtrD alleles was revealed to indicate the cooperative molecular evolution of these genes. A link between the mtrR and mtrD alleles and NG-MAST types was found only for NG-MAST 228 and 807, typical of N. gonorrhoeae in Russia. The high level of resistance to azithromycin in Russia may be related to the spread of multiple transferable resistance to antimicrobials regardless of their use in the treatment of gonococcal infection.
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Affiliation(s)
- Ilya Kandinov
- Center for Precision Genome Editing and Genetic Technologies for Biomedicine, Engelhardt Institute of Molecular Biology, Russian Academy of Sciences, Moscow 119991, Russia
- Correspondence:
| | - Boris Shaskolskiy
- Center for Precision Genome Editing and Genetic Technologies for Biomedicine, Engelhardt Institute of Molecular Biology, Russian Academy of Sciences, Moscow 119991, Russia
| | - Dmitry Kravtsov
- Center for Precision Genome Editing and Genetic Technologies for Biomedicine, Engelhardt Institute of Molecular Biology, Russian Academy of Sciences, Moscow 119991, Russia
| | - Alexandra Vinokurova
- Center for Precision Genome Editing and Genetic Technologies for Biomedicine, Engelhardt Institute of Molecular Biology, Russian Academy of Sciences, Moscow 119991, Russia
| | - Sofya Gorshkova
- Center for Precision Genome Editing and Genetic Technologies for Biomedicine, Engelhardt Institute of Molecular Biology, Russian Academy of Sciences, Moscow 119991, Russia
| | - Alexey Kubanov
- State Research Center of Dermatovenerology and Cosmetology, Russian Ministry of Health, Moscow 107076, Russia
| | - Victoria Solomka
- State Research Center of Dermatovenerology and Cosmetology, Russian Ministry of Health, Moscow 107076, Russia
| | - Julia Shagabieva
- State Research Center of Dermatovenerology and Cosmetology, Russian Ministry of Health, Moscow 107076, Russia
| | - Dmitry Deryabin
- State Research Center of Dermatovenerology and Cosmetology, Russian Ministry of Health, Moscow 107076, Russia
| | - Ekaterina Dementieva
- Center for Precision Genome Editing and Genetic Technologies for Biomedicine, Engelhardt Institute of Molecular Biology, Russian Academy of Sciences, Moscow 119991, Russia
| | - Dmitry Gryadunov
- Center for Precision Genome Editing and Genetic Technologies for Biomedicine, Engelhardt Institute of Molecular Biology, Russian Academy of Sciences, Moscow 119991, Russia
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6
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Lu Z, Tadi DA, Fu J, Azizian K, Kouhsari E. Global status of Azithromycin and Erythromycin Resistance Rates in Neisseria gonorrhoeae: A Systematic Review and Meta-analysis. THE YALE JOURNAL OF BIOLOGY AND MEDICINE 2022; 95:465-478. [PMID: 36568835 PMCID: PMC9765340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Background: The widespread development of antibiotic resistance or decreased susceptibility in Neisseria gonorrhoeae (NG) infection is a global and significant human public health issue. Objectives: Therefore, this meta-analysis aimed to estimate worldwide resistance rates of NG to the azithromycin and erythromycin according to years, regions, and antimicrobial susceptibility testing (AST). Methods: We systematically searched the published studies in PubMed, Scopus, and Embase from 1988 to 2021. All analyses were conducted using Stata software. Results: The 134 reports included in the meta-analysis were performed in 51 countries and examined 165,172 NG isolates. Most of the included studies were from Asia (50 studies) and Europe (46 studies). In the metadata, the global prevalence over the past 30 years were 6% for azithromycin and 48% for erythromycin. There was substantial change in the prevalence of macrolides NG resistance over time (P <0.01). In this metadata, among 58 countries reporting resistance data for azithromycin, 17 (29.3%) countries reported that >5% of specimens had azithromycin resistance. Conclusions: The implications of this study emphasize the rigorous or improved antimicrobial stewardship, early diagnosis, contact tracing, and enhanced intensive global surveillance system are crucial for control of further spreading of gonococcal emergence of antimicrobial resistance (AMR).
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Affiliation(s)
- Zhiwei Lu
- Graduate School, Zhejiang Chinese Medical University,
Hangzhou, Zhejiang, China,Hangzhou Heyunjia Hospital, Hangzhou, Zhejiang,
China
| | - Danyal Abbasi Tadi
- Department of Veterinary, Azad University of Shahr-e
Kord, Shahr-e Kord, Iran
| | - Jinchao Fu
- Department of General Practice, Shulan (Hangzhou)
Hospital Affiliated to Zhejiang Shuren University Shulan International Medical
College, Hangzhou, Zhejiang, China,To whom all correspondence should be addressed:
Jinchao Fu, ; Ebrahim Kouhsari,
; ORCID:
https://www.orcid.org/0000-0001-5893-6483
| | - Khalil Azizian
- Department of Microbiology, Faculty of Medicine,
Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Ebrahim Kouhsari
- Laboratory Sciences Research Center, Golestan
University of Medical Sciences, Gorgan, Iran,Department of Laboratory Sciences, Faculty of
Paramedicine, Golestan University of Medical Sciences, Gorgan, Iran,To whom all correspondence should be addressed:
Jinchao Fu, ; Ebrahim Kouhsari,
; ORCID:
https://www.orcid.org/0000-0001-5893-6483
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Dos Santos TF, Goveia MR, Moraes GM, Tavares MA, Davalos SR, Campos CB, de Oliveira FA, Benitez DF, Tavares MB, Colli EDH, Pinheiro ME, Rodrigues BDR, Neto CD, Ribeiro RS. Gonococci resistant to current antimicrobial management standards: a new threat to global public health. Future Microbiol 2022; 17:1241-1247. [PMID: 36006076 DOI: 10.2217/fmb-2022-0110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023] Open
Abstract
Gonorrhea is the second most common sexually transmitted bacterial infection on the planet and is caused by a Gram-negative cocco, Neisseria gonorrhoeae. Currently, the preferred regimen for the management of this disease in Brazil is a combination of antimicrobials, in this case, ceftriaxone and azithromycin. However, over time, the gonococcus developed a decrease in susceptibility to the regimen used, which resulted in frank resistance to antimicrobials, progressively reducing the therapeutic options available. Thus, the study presented here aims to analyze and discuss the current scenario of resistance of N. gonorrhoeae to the antimicrobials used to date, to encourage discussion on the subject in the academic environment. For this purpose, 47 articles indexed in the Bireme, PubMed, Scielo and UpToDate platforms were selected.
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Affiliation(s)
| | | | | | - Marco Asb Tavares
- Federal University of Mato Grosso do Sul, UFMS, Campo Grande, Brazil
| | - Silvio Ra Davalos
- Federal University of Mato Grosso do Sul, UFMS, Campo Grande, Brazil
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8
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Visser M, Götz HM, van Dam AP, van Benthem BH. Trends and regional variations of gonococcal antimicrobial resistance in the Netherlands, 2013 to 2019. EURO SURVEILLANCE : BULLETIN EUROPEEN SUR LES MALADIES TRANSMISSIBLES = EUROPEAN COMMUNICABLE DISEASE BULLETIN 2022; 27. [PMID: 36017715 PMCID: PMC9413857 DOI: 10.2807/1560-7917.es.2022.27.34.2200081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Background Gonococcal antimicrobial resistance is emerging worldwide and is monitored in the Netherlands in 18 of 24 Sexual Health Centres (SHC). Aim To report trends, predictors and regional variation of gonococcal azithromycin resistance (AZI-R, minimum inhibitory concentration (MIC) > 1 mg/L) and ceftriaxone decreased susceptibility (CEF-DS, MIC > 0.032 mg/L) in 2013–2019. Methods SHC reported data on individual characteristics, sexually transmitted infection diagnoses, and susceptibility testing (MIC, measured by Etest). We used multilevel logistic regression analysis to identify AZI-R/CEF-DS predictors, correcting for SHC region. Population differences’ effect on regional variance of AZI-R and CEF-DS was assessed with a separate multilevel model. Results The study included 13,172 isolates, predominantly (n = 9,751; 74%) from men who have sex with men (MSM). Between 2013 and 2019, annual proportions of AZI-R isolates appeared to increase from 2.8% (37/1,304) to 9.3% (210/2,264), while those of CEF-DS seemed to decrease from 7.0% (91/1,306) to 2.9% (65/2,276). Among SHC regions, 0.0‒16.9% isolates were AZI-R and 0.0−7.0% CEF-DS; population characteristics could not explain regional variance. Pharyngeal strain origin and consultation year were significantly associated with AZI-R and CEF-DS for MSM, women, and heterosexual men. Among women and heterosexual men ≥ 4 partners was associated with CEF-DS, and ≥ 10 with AZI-R. Conclusions No resistance or decreasing susceptibility was found for CEF, the first line gonorrhoea treatment in the Netherlands. Similar to trends worldwide, AZI-R appeared to increase. Regional differences between SHC support nationwide surveillance with regional-level reporting. The increased risk of resistance/decreased susceptibility in pharyngeal strains underlines the importance of including extragenital infections in gonococcal resistance surveillance.
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Affiliation(s)
- Maartje Visser
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Hannelore M Götz
- Department Infectious Disease Control, Municipal Public Health Service Rotterdam-Rijnmond (GGD Rotterdam), Rotterdam, the Netherlands.,Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Alje P van Dam
- National Reference Laboratory for Neisseria gonorrhoeae, Public Health Laboratory, Amsterdam Health Service, Amsterdam, the Netherlands
| | - Birgit Hb van Benthem
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
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9
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Zolfaghari P, Emamie AD, Rajabpour M, Zarei A, Whiley DM, Pourmand MR, Pourmand G. Antimicrobial susceptibility testing and molecular characterization of Neisseria gonorrhoeae in Tehran, Iran. Int J STD AIDS 2022; 33:660-665. [PMID: 35485393 DOI: 10.1177/09564624221091746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Gonorrhea is a sexually transmitted infection occurring worldwide. Antimicrobial resistance (AMR) surveillance in Neisseria gonorrhoeae and associated molecular epidemiological studies are crucial to ascertain the spread of antibiotic-resistant and developing the local treatment guidelines. This study was performed to determine the antimicrobial susceptibility testing (AST) and molecular epidemiology of N. gonorrhoeae isolates in Tehran, Iran. During 1 July 2018-30 July 2020, a total of 500 urogenital (468 endocervical, 32 urethral) swabs were collected from patients with signs and symptoms of genitourinary infections presenting to two women's hospitals and one health center located center and south of Tehran. Specimens were cultured and examined for the presence of N. gonorrhoeae isolates by biochemical tests. MIC Test Strip determined the MICs of ceftriaxone, azithromycin, and ciprofloxacin. Neisseria gonorrhoeae multiantigen sequence typing (NG-MAST) was also performed. A total of 38 N. gonorrhoeae isolates were identified. The proportions of resistant N. gonorrhoeae isolates were as follows: ceftriaxone (MIC ≥0.125 μg/mL) 10.5% (4/38), azithromycin (MIC >1 μg/mL) 34% (13/38), and ciprofloxacin (MIC ≥1 μg/mL) 31.5% (12/38). In total, 25 different NG-MAST STs were identified. The STs comprised 1-4 isolates each, and the predominant ST was ST266 (n = 4). Our study demonstrates a diverse gonococcal population with high rates of resistance to azithromycin and evidence of resistance to ceftriaxone. The results have potential implications for antibiotic choice for the gonococcal treatment and highlight the need to broaden gonococcal AMR monitoring in Iran.
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Affiliation(s)
- Pouria Zolfaghari
- Department of Pathobiology, School of Public Health, 48439Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Darb Emamie
- Department of Pathobiology, School of Public Health, 48439Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Rajabpour
- Department of Pathobiology, School of Public Health, 48439Tehran University of Medical Sciences, Tehran, Iran
| | - Atefe Zarei
- Department of Pathobiology, School of Public Health, 48439Tehran University of Medical Sciences, Tehran, Iran
| | - David M Whiley
- Faculty of Medicine, Centre for Clinical Research, 1974The University of Queensland, Herston, QLD, Australia
| | - Mohammad Reza Pourmand
- Department of Pathobiology, School of Public Health, 48439Tehran University of Medical Sciences, Tehran, Iran
| | - Gholamreza Pourmand
- Uro-Oncology Research Center, 48439Tehran University of Medical Sciences, Tehran, Iran
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10
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Lin EY, Adamson PC, Ha SM, Klausner JD. Reliability of Genetic Alterations in Predicting Ceftriaxone Resistance in Neisseria gonorrhoeae Globally. Microbiol Spectr 2022; 10:e0206521. [PMID: 35348352 PMCID: PMC9045316 DOI: 10.1128/spectrum.02065-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 02/20/2022] [Indexed: 11/29/2022] Open
Abstract
Antimicrobial resistance in N. gonorrhoeae is increasing globally, and ceftriaxone is the recommended treatment for empirical therapy in most settings. Developing molecular assays to detect decreased ceftriaxone susceptibility is critical. Using PathogenWatch, a public database of N. gonorrhoeae genomes, antibiotic susceptibility data and DNA sequences of different genes associated with ceftriaxone resistance were extracted. That information was used to determine the sensitivity and specificity of different molecular markers and algorithms to predict decreased susceptibility to ceftriaxone. A total of 12,943 N. gonorrhoeae genomes were extracted from the PathogenWatch database, of which 9,540 genomes were used in the analysis. The sensitivity and specificity of specific molecular markers and algorithms were largely consistent with prior reports. Small variation (<10%) in either sensitivity or specificity occurred. Certain algorithms using different molecular markers at various prevalence of decreased ceftriaxone susceptibility identified a potentially clinically useful range of positive and negative predictive values. We validated previously described mutations and algorithms in a large public database containing a global collection of N. gonorrhoeae genomes. Certain mutations and algorithms resulted in sensitivity and specificity values consistent with those of prior studies. Further research is needed to integrate these markers and algorithms into the development of molecular assays to predict decreased ceftriaxone susceptibility. IMPORTANCE Antimicrobial resistance in Neisseria gonorrhoeae (N. gonorrhoeae), the causative agent of gonorrhea, is rising globally. Ceftriaxone is the last remaining antibiotic for empirical treatment of gonorrhea. Developing molecular tests to predict ceftriaxone resistance can help to improve detection and surveillance of ceftriaxone resistance. Here, we utilized PathogenWatch, a public global online database of N. gonorrhoeae genomes, to evaluate different genetic markers in predicting decreased susceptibility to ceftriaxone. We compiled MICs for ceftriaxone from the PathogenWatch database and used a computational approach to extract all the genetic markers from the genomic data. We determined the sensitivity and specificity for predicting decreased ceftriaxone susceptibility among several combinations of genetic markers. We identified several combinations of genetic markers with high predictive values for decreased susceptibility to ceftriaxone. These combinations of genetic markers might be promising candidates for future molecular tests to predict ceftriaxone resistance.
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Affiliation(s)
- Eric Yu Lin
- David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Paul C. Adamson
- Division of Infectious Diseases, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Sung-min Ha
- Department of Integrative Biology and Physiology, UCLA, Los Angeles, California, USA
| | - Jeffrey D. Klausner
- Department of Population and Public Health Sciences, Keck School of Medicine of USC, Los Angeles, California, USA
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11
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Abstract
Neisseria gonorrhoeae is an obligate human pathogen that is the cause of the sexually transmitted disease gonorrhoea. Recently, there has been a surge in gonorrhoea cases that has been exacerbated by the rapid rise in gonococcal multidrug resistance to all useful antimicrobials resulting in this organism becoming a significant public health burden. Therefore, there is a clear and present need to understand the organism's biology through its physiology and pathogenesis to help develop new intervention strategies. The gonococcus initially colonises and adheres to host mucosal surfaces utilising a type IV pilus that helps with microcolony formation. Other adhesion strategies include the porin, PorB, and the phase variable outer membrane protein Opa. The gonococcus is able to subvert complement mediated killing and opsonisation by sialylation of its lipooligosaccharide and deploys a series of anti-phagocytic mechanisms. N. gonorrhoeae is a fastidious organism that is able to grow on a limited number of primary carbon sources such as glucose and lactate. The utilization of lactate by the gonococcus has been implicated in a number of pathogenicity mechanisms. The bacterium lives mainly in microaerobic environments and can grow both aerobically and anaerobically with the aid of nitrite. The gonococcus does not produce siderophores for scavenging iron but can utilize some produced by other bacteria, and it is able to successful chelate iron from host haem, transferrin and lactoferrin. The gonococcus is an incredibly versatile human pathogen; in the following chapter, we detail the intricate mechanisms used by the bacterium to invade and survive within the host.
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Affiliation(s)
- Luke R Green
- Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
| | - Joby Cole
- Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
| | - Ernesto Feliz Diaz Parga
- Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
| | - Jonathan G Shaw
- Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom.
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12
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Abstract
Antimicrobials are essential in reducing morbidity and mortality from infectious diseases globally. However, due to the lack of effective surveillance measures and widespread overuse, there is an increasing threat to the effectiveness of antimicrobials. Although there is a global increase in antimicrobial resistance, low- and middle-income countries share a much higher burden. Antimicrobial stewardship efforts such as effective surveillance and reduction in overuse can help combat the increase in antimicrobial resistance.
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Affiliation(s)
- Prachi Singh
- Department of Pediatrics, Division of Pediatric Infectious Diseases and Global Health, UCSF Benioff Children's Hospital, Oakland, 747 52nd Street, Oakland, CA 94609, USA.
| | - Jenna Holmen
- Department of Pediatrics, Division of Pediatric Infectious Diseases and Global Health, UCSF Benioff Children's Hospital, Oakland, 747 52nd Street, Oakland, CA 94609, USA
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13
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Saeed DK, Farooqi J, Shakoor S, Hasan R. Antimicrobial resistance among GLASS priority pathogens from Pakistan: 2006-2018. BMC Infect Dis 2021; 21:1231. [PMID: 34876041 PMCID: PMC8650393 DOI: 10.1186/s12879-021-06795-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 10/08/2021] [Indexed: 11/20/2022] Open
Abstract
Background In 2018 Pakistan initiated its national antimicrobial resistance (AMR) surveillance aligned with Global Antimicrobial Surveillance System (GLASS). To complement this surveillance, we conducted a situational analysis of AMR rates among GLASS organisms in the country. Data from published studies and from antibiograms was compared and role of antibiograms as potential contributors to national AMR surveillance explored. Methods AMR rates for GLASS specified pathogen/antimicrobials combination from Pakistan were reviewed. Data sources included published studies (2006–2018) providing AMR rates from Pakistan (n = 54) as well as antibiograms (2011–2018) available on the Pakistan Antimicrobial Resistance Network (PARN) website. Resistance rates were categorized as follows: Very low: 0–10%, Low: 11–30%, Moderate: 30–50% and High: > 50%. Results Published data from hospital and community/laboratory-based studies report resistance rates of > 50% and 30–50% respectively to 3rd generation cephalosporins, fluoroquinolones and cotrimoxazole amongst Klebsiella pneumoniae and Escherichia coli. Carbapenem resistance rates amongst these organisms remained below 30%. High (> 50%) resistance was reported in Acinetobacter species to aminoglycosides and carbapenems among hospitalized patients. The evolution of ceftriaxone resistant Salmonella Typhi and Shigella species is reported. The data showed > 50% to fluoroquinolones amongst Neisseria gonorrhoeae and the spread of methicillin resistant Staphylococcus aureus (< 30%; 2008) to (> 50%; 2010) in hospital settings. Resistance reported in published studies aligned well with antibiogram data. The latter also captured a clear picture of evolution of resistance over the study period. Conclusion Both published studies as well antibiograms suggest high rates of AMR in Pakistan. Antibiogram data demonstrating steady increase in AMR highlight its potential role towards supplementing national AMR surveillance efforts particularly in settings where reach of national surveillance may be limited. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-021-06795-0.
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Affiliation(s)
- Dania Khalid Saeed
- Department of Pathology and Laboratory Medicine, The Aga Khan University, Karachi, 74800, Pakistan
| | - Joveria Farooqi
- Department of Pathology and Laboratory Medicine, The Aga Khan University, Karachi, 74800, Pakistan
| | - Sadia Shakoor
- Department of Pathology and Laboratory Medicine, The Aga Khan University, Karachi, 74800, Pakistan
| | - Rumina Hasan
- Department of Pathology and Laboratory Medicine, The Aga Khan University, Karachi, 74800, Pakistan. .,Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK.
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14
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Lin EY, Adamson PC, Klausner JD. Epidemiology, Treatments, and Vaccine Development for Antimicrobial-Resistant Neisseria gonorrhoeae: Current Strategies and Future Directions. Drugs 2021; 81:1153-1169. [PMID: 34097283 PMCID: PMC8182353 DOI: 10.1007/s40265-021-01530-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2021] [Indexed: 12/12/2022]
Abstract
Neisseria gonorrhoeae is the second most common bacterial sexually transmitted infection in the world after Chlamydia trachomatis. The pathogen has developed resistance to every antibiotic currently approved for treatment, and multidrug-resistant strains have been identified globally. The current treatment recommended by the World Health Organization is ceftriaxone and azithromycin dual therapy. However, resistance to azithromycin and ceftriaxone are increasing and treatment failures have been reported. As a result, there is a critical need to develop novel strategies for mitigating the spread of antimicrobial-resistant N. gonorrhoeae through improved diagnosis and treatment of resistant infections. Strategies that are currently being pursued include developing molecular assays to predict resistance, utilizing higher doses of ceftriaxone, repurposing older antibiotics, and developing newer agents. In addition, efforts to discover a vaccine for N. gonorrhoeae have been reignited in recent years with the cross-protectivity provided by the N. meningitidis vaccine, with several new strategies and targets. Despite the significant progress that has been made, there is still much work ahead to combat antimicrobial-resistant N. gonorrhoeae globally.
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Affiliation(s)
- Eric Y Lin
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Paul C Adamson
- Division of Infectious Diseases, David Geffen School of Medicine at UCLA, 10833 Le Conte Ave. CHS 52-215, Los Angeles, CA, 90095, USA
| | - Jeffrey D Klausner
- Department of Preventive Medicine, Keck School of Medicine of USC, Los Angeles, CA, USA.
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15
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Fouéré S, Cazanave C, Hélary M, Dupin N, Tattevin P, Bébéar C, Beylot-Barry M, Molina JM, Chosidow O, Riche A, Berçot B. Update on French recommendations for the treatment of uncomplicated Neisseria gonorrhoeae infections. Int J STD AIDS 2021; 32:1081-1083. [PMID: 34125636 DOI: 10.1177/09564624211023025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Sébastien Fouéré
- SFD/GRIDIST and Centre for Genital and Sexually Transmitted Diseases, 55663APHP-Hospital Saint-Louis, Paris, France
| | - Charles Cazanave
- SPILF and Infectious Diseases, 36836Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France.,INRAE, IHMC, USC EA 3671,3671 University of Bordeaux, Bordeaux, France
| | - Marion Hélary
- Bacteriology and National Reference Centre for Bacterial Sexually Transmitted Infections,36836 Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Nicolas Dupin
- SFD/GRIDIST and Dermatology and Sexually Transmitted Infections - National Reference Centre for Bacterial Sexually Transmitted Infections, APHP-Cochin Hospital, Paris, France
| | - Pierre Tattevin
- SPILF and Infectious Diseases and ICU, Pontchaillou University Hospital, Rennes, France
| | - Cécile Bébéar
- INRAE, IHMC, USC EA 3671,3671 University of Bordeaux, Bordeaux, France
| | - Marie Beylot-Barry
- SFD and Dermatology and Venereology, Centre Hospitalier Universitaire de Bordeaux, Bordeau, France
| | - Jean-Michel Molina
- SPILF and Infectious and Tropical Diseases, APHP-Hospital Saint-Louis, Paris, France
| | - Olivier Chosidow
- SFD/GRIDIST and Dermatology, APHP-Hospital Henri Mondor, Créteil, France
| | - Agnès Riche
- SPILF and Infectious Diseases and Internal Medicine, 37080Hospital Centre Angoulème, Angoulème, France
| | - Béatrice Berçot
- Bacteriology and National Reference Centre for Bacterial Sexually Transmitted Infections, APHP-Hospital Saint Louis, Paris, France.,INSERM, IAME, UMR 1137, University of Paris, Paris, France
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16
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Jamoralin MC, Argimón S, Lagrada ML, Villamin AS, Masim ML, Gayeta JM, Boehme KD, Olorosa AM, Sia SB, Hufano CM, Cohen V, Hernandez LT, Jeffrey B, Abudahab K, Stelling J, Holden MTG, Aanensenb DM, Carlosa CC. Genomic surveillance of Neisseria gonorrhoeae in the Philippines, 2013-2014. Western Pac Surveill Response J 2021; 12:17-25. [PMID: 34094619 PMCID: PMC8143934 DOI: 10.5365/wpsar.2020.11.1.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Antimicrobial-resistant Neisseria gonorrhoeae is a major threat to public health and is of particular concern in the Western Pacific Region, where the incidence of gonorrhoea is high. The Antimicrobial Resistance Surveillance Program (ARSP) has been capturing information on resistant gonorrhoea since 1996, but genomic epidemiology studies on this pathogen are lacking in the Philippines. We sequenced the whole genomes of 21 N. gonorrhoeae isolates collected in 2013-2014 by ARSP. The multilocus sequence type, multiantigen sequence type, presence of determinants of antimicrobial resistance and relatedness among the isolates were all derived from the sequence data. The concordance between phenotypic and genotypic resistance was also determined. Ten of 21 isolates were resistant to penicillin, ciprofloxacin and tetracycline, due mainly to the presence of the blaTEM gene, the S91F mutation in the gyrA gene and the tetM gene, respectively. None of the isolates was resistant to ceftriaxone or cefixime. The concordance between phenotypic and genotypic resistance was 92.38% overall for five antibiotics in four classes. Despite the small number of isolates studied, they were genetically diverse, as shown by the sequence types, the N. gonorrhoeae multiantigen sequence typing types and the tree. Comparison with global genomes placed the Philippine genomes within global lineage A and led to the identification of an international transmission route. This first genomic survey of N. gonorrhoeae isolates collected by ARSP will be used to contextualize prospective surveillance. It highlights the importance of genomic surveillance in the Western Pacific and other endemic regions for understanding the spread of drug-resistant gonorrhoea worldwide.
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Affiliation(s)
- Manuel C Jamoralin
- Antimicrobial Resistance Surveillance Reference Laboratory, Research Institute for Tropical Medicine, Muntinlupa, Philippines
| | - Silvia Argimón
- Centre for Genomic Pathogen Surveillance, Wellcome Genome Campus, Hinxton, England, United Kingdom
| | - Marietta L Lagrada
- Antimicrobial Resistance Surveillance Reference Laboratory, Research Institute for Tropical Medicine, Muntinlupa, Philippines
- Centre for Genomic Pathogen Surveillance, Wellcome Genome Campus, Hinxton, England, United Kingdom
- Brigham and Women's Hospital, Boston (MA), USA
- University of St Andrews School of Medicine, St Andrews, Scotland, United Kingdom
- Centre for Genomic Pathogen Surveillance, Big Data Institute, University of Oxford, Oxford, England, United Kingdom
- These authors contributed equally to this work
- These authors contributed equally to this work
| | - Alfred S Villamin
- Antimicrobial Resistance Surveillance Reference Laboratory, Research Institute for Tropical Medicine, Muntinlupa, Philippines
- Centre for Genomic Pathogen Surveillance, Wellcome Genome Campus, Hinxton, England, United Kingdom
- Brigham and Women's Hospital, Boston (MA), USA
- University of St Andrews School of Medicine, St Andrews, Scotland, United Kingdom
- Centre for Genomic Pathogen Surveillance, Big Data Institute, University of Oxford, Oxford, England, United Kingdom
- These authors contributed equally to this work
- These authors contributed equally to this work
| | - Melissa L Masim
- Antimicrobial Resistance Surveillance Reference Laboratory, Research Institute for Tropical Medicine, Muntinlupa, Philippines
- Centre for Genomic Pathogen Surveillance, Wellcome Genome Campus, Hinxton, England, United Kingdom
- Brigham and Women's Hospital, Boston (MA), USA
- University of St Andrews School of Medicine, St Andrews, Scotland, United Kingdom
- Centre for Genomic Pathogen Surveillance, Big Data Institute, University of Oxford, Oxford, England, United Kingdom
- These authors contributed equally to this work
- These authors contributed equally to this work
| | - June M Gayeta
- Antimicrobial Resistance Surveillance Reference Laboratory, Research Institute for Tropical Medicine, Muntinlupa, Philippines
- Centre for Genomic Pathogen Surveillance, Wellcome Genome Campus, Hinxton, England, United Kingdom
- Brigham and Women's Hospital, Boston (MA), USA
- University of St Andrews School of Medicine, St Andrews, Scotland, United Kingdom
- Centre for Genomic Pathogen Surveillance, Big Data Institute, University of Oxford, Oxford, England, United Kingdom
- These authors contributed equally to this work
- These authors contributed equally to this work
| | - Karis D Boehme
- Antimicrobial Resistance Surveillance Reference Laboratory, Research Institute for Tropical Medicine, Muntinlupa, Philippines
- Centre for Genomic Pathogen Surveillance, Wellcome Genome Campus, Hinxton, England, United Kingdom
- Brigham and Women's Hospital, Boston (MA), USA
- University of St Andrews School of Medicine, St Andrews, Scotland, United Kingdom
- Centre for Genomic Pathogen Surveillance, Big Data Institute, University of Oxford, Oxford, England, United Kingdom
- These authors contributed equally to this work
- These authors contributed equally to this work
| | - Agnettah M Olorosa
- Antimicrobial Resistance Surveillance Reference Laboratory, Research Institute for Tropical Medicine, Muntinlupa, Philippines
- Centre for Genomic Pathogen Surveillance, Wellcome Genome Campus, Hinxton, England, United Kingdom
- Brigham and Women's Hospital, Boston (MA), USA
- University of St Andrews School of Medicine, St Andrews, Scotland, United Kingdom
- Centre for Genomic Pathogen Surveillance, Big Data Institute, University of Oxford, Oxford, England, United Kingdom
- These authors contributed equally to this work
- These authors contributed equally to this work
| | - Sonia B Sia
- Antimicrobial Resistance Surveillance Reference Laboratory, Research Institute for Tropical Medicine, Muntinlupa, Philippines
- Centre for Genomic Pathogen Surveillance, Wellcome Genome Campus, Hinxton, England, United Kingdom
- Brigham and Women's Hospital, Boston (MA), USA
- University of St Andrews School of Medicine, St Andrews, Scotland, United Kingdom
- Centre for Genomic Pathogen Surveillance, Big Data Institute, University of Oxford, Oxford, England, United Kingdom
- These authors contributed equally to this work
- These authors contributed equally to this work
| | - Charmian M Hufano
- Antimicrobial Resistance Surveillance Reference Laboratory, Research Institute for Tropical Medicine, Muntinlupa, Philippines
- Centre for Genomic Pathogen Surveillance, Wellcome Genome Campus, Hinxton, England, United Kingdom
- Brigham and Women's Hospital, Boston (MA), USA
- University of St Andrews School of Medicine, St Andrews, Scotland, United Kingdom
- Centre for Genomic Pathogen Surveillance, Big Data Institute, University of Oxford, Oxford, England, United Kingdom
- These authors contributed equally to this work
- These authors contributed equally to this work
| | - Victoria Cohen
- Antimicrobial Resistance Surveillance Reference Laboratory, Research Institute for Tropical Medicine, Muntinlupa, Philippines
- Centre for Genomic Pathogen Surveillance, Wellcome Genome Campus, Hinxton, England, United Kingdom
- Brigham and Women's Hospital, Boston (MA), USA
- University of St Andrews School of Medicine, St Andrews, Scotland, United Kingdom
- Centre for Genomic Pathogen Surveillance, Big Data Institute, University of Oxford, Oxford, England, United Kingdom
- These authors contributed equally to this work
- These authors contributed equally to this work
| | - Lara T Hernandez
- Antimicrobial Resistance Surveillance Reference Laboratory, Research Institute for Tropical Medicine, Muntinlupa, Philippines
- Centre for Genomic Pathogen Surveillance, Wellcome Genome Campus, Hinxton, England, United Kingdom
- Brigham and Women's Hospital, Boston (MA), USA
- University of St Andrews School of Medicine, St Andrews, Scotland, United Kingdom
- Centre for Genomic Pathogen Surveillance, Big Data Institute, University of Oxford, Oxford, England, United Kingdom
- These authors contributed equally to this work
- These authors contributed equally to this work
| | - Benjamin Jeffrey
- Antimicrobial Resistance Surveillance Reference Laboratory, Research Institute for Tropical Medicine, Muntinlupa, Philippines
- Centre for Genomic Pathogen Surveillance, Wellcome Genome Campus, Hinxton, England, United Kingdom
- Brigham and Women's Hospital, Boston (MA), USA
- University of St Andrews School of Medicine, St Andrews, Scotland, United Kingdom
- Centre for Genomic Pathogen Surveillance, Big Data Institute, University of Oxford, Oxford, England, United Kingdom
- These authors contributed equally to this work
- These authors contributed equally to this work
| | - Khalil Abudahab
- Antimicrobial Resistance Surveillance Reference Laboratory, Research Institute for Tropical Medicine, Muntinlupa, Philippines
- Centre for Genomic Pathogen Surveillance, Wellcome Genome Campus, Hinxton, England, United Kingdom
- Brigham and Women's Hospital, Boston (MA), USA
- University of St Andrews School of Medicine, St Andrews, Scotland, United Kingdom
- Centre for Genomic Pathogen Surveillance, Big Data Institute, University of Oxford, Oxford, England, United Kingdom
- These authors contributed equally to this work
- These authors contributed equally to this work
| | - John Stelling
- Antimicrobial Resistance Surveillance Reference Laboratory, Research Institute for Tropical Medicine, Muntinlupa, Philippines
- Centre for Genomic Pathogen Surveillance, Wellcome Genome Campus, Hinxton, England, United Kingdom
- Brigham and Women's Hospital, Boston (MA), USA
- University of St Andrews School of Medicine, St Andrews, Scotland, United Kingdom
- Centre for Genomic Pathogen Surveillance, Big Data Institute, University of Oxford, Oxford, England, United Kingdom
- These authors contributed equally to this work
- These authors contributed equally to this work
| | - Matthew T G Holden
- Antimicrobial Resistance Surveillance Reference Laboratory, Research Institute for Tropical Medicine, Muntinlupa, Philippines
- Centre for Genomic Pathogen Surveillance, Wellcome Genome Campus, Hinxton, England, United Kingdom
- Brigham and Women's Hospital, Boston (MA), USA
- University of St Andrews School of Medicine, St Andrews, Scotland, United Kingdom
- Centre for Genomic Pathogen Surveillance, Big Data Institute, University of Oxford, Oxford, England, United Kingdom
- These authors contributed equally to this work
- These authors contributed equally to this work
| | - David M Aanensenb
- Antimicrobial Resistance Surveillance Reference Laboratory, Research Institute for Tropical Medicine, Muntinlupa, Philippines
- Centre for Genomic Pathogen Surveillance, Wellcome Genome Campus, Hinxton, England, United Kingdom
- Brigham and Women's Hospital, Boston (MA), USA
- University of St Andrews School of Medicine, St Andrews, Scotland, United Kingdom
- Centre for Genomic Pathogen Surveillance, Big Data Institute, University of Oxford, Oxford, England, United Kingdom
- These authors contributed equally to this work
- These authors contributed equally to this work
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17
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Adamson PC, Van Le H, Le HHL, Le GM, Nguyen TV, Klausner JD. Trends in antimicrobial resistance in Neisseria gonorrhoeae in Hanoi, Vietnam, 2017-2019. BMC Infect Dis 2020; 20:809. [PMID: 33153450 PMCID: PMC7643326 DOI: 10.1186/s12879-020-05532-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 10/20/2020] [Indexed: 11/10/2022] Open
Abstract
Background Antimicrobial resistance (AMR) in Neisseria gonorrhoeae is an emerging global health threat. Surveillance of AMR in N. gonorrhoeae in the Western Pacific Region is important, as resistant strains have typically emerged from this region. There are sparse data regarding antibiotic susceptibility of N. gonorrhoeae from Vietnam. This study aimed to provide updated data on antibiotic susceptibilities in N. gonorrhoeae isolates from Hanoi, Vietnam. Methods From 2017 to 2019, 409 N. gonorrhoeae clinical isolates were collected at the National Hospital for Venereology and Dermatology in Hanoi, Vietnam. Antibiotic susceptibility testing was performed by disk diffusion method according to the Clinical and Laboratory Standards Institute (CLSI) protocol. The zone diameters of inhibition were recorded and interpreted according to standard CLSI criteria, except for azithromycin, due to the absence of CLSI interpretation. Categorical variables were analyzed by Chi-square and Fisher’s exact tests. Linear regression was used to evaluate zones of inhibition by year. Results Among the 409 isolates, no isolates were susceptible to penicillin, 98.3% were resistant to ciprofloxacin, and all isolates were susceptible to spectinomycin. There were 122/407 (30.0%) isolates resistant to azithromycin and there was an association between resistance and year (p < 0.01), ranging from 15.3% of isolates in 2017 to 46.7% of the isolates in 2018. Resistance to cefixime was found in 13/406 (3.2%) of isolates and there was no association by year (p = 0.30). Resistance to ceftriaxone occurred in 3/408 (0.7%) of isolates. Linear regression indicated the zone of inhibition diameters decreased by 0.83 mm each year for ceftriaxone (95% CI: − 1.3, − 0.4; p < 0.01) and decreased by 0.83 mm each year (95% CI: − 1.33, − 0.33; p < 0.01) for azithromycin; the association was not significant for cefixime (p = 0.07). Conclusions We found decreasing susceptibility of N. gonorrhoeae to ceftriaxone and azithromycin, as well as a high prevalence of resistance to azithromycin, among isolates in Hanoi, Vietnam from 2017 to 2019. The trends of decreasing susceptibility to first-line treatments are concerning and highlight the urgency of addressing antimicrobial resistance in N. gonorrhoeae. Expanded surveillance efforts within the Western Pacific Region are critical to monitoring trends and informing treatment guidelines.
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Affiliation(s)
- Paul C Adamson
- Division of Infectious Diseases, David Geffen School of Medicine at UCLA, 10833 Le Conte Avenue CHS 52-215, Los Angeles, CA, USA.
| | - Hung Van Le
- National Hospital of Venereology and Dermatology, Hanoi, Vietnam.,Hanoi Medical University, Hanoi, Vietnam
| | - Hai Ha Long Le
- National Hospital of Venereology and Dermatology, Hanoi, Vietnam.,Hanoi Medical University, Hanoi, Vietnam
| | | | - Trung Vu Nguyen
- Hanoi Medical University, Hanoi, Vietnam.,National Hospital for Tropical Diseases, Hanoi, Vietnam
| | - Jeffrey D Klausner
- Division of Infectious Diseases, David Geffen School of Medicine at UCLA, 10833 Le Conte Avenue CHS 52-215, Los Angeles, CA, USA.,Department of Epidemiology, Fielding School of Public Health, UC Los Angeles, Los Angeles, CA, USA
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18
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George CRR, Kundu RL, Whiley DM, Lahra MM. Are sex norms the norm in gonococcal surveillance? LANCET MICROBE 2020; 1:e143-e144. [DOI: 10.1016/s2666-5247(20)30087-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 06/05/2020] [Indexed: 11/26/2022]
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19
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Gernert KM, Seby S, Schmerer MW, Thomas JC, Pham CD, Cyr SS, Schlanger K, Weinstock H, Shafer WM, Raphael BH, Kersh EN. Azithromycin susceptibility of Neisseria gonorrhoeae in the USA in 2017: a genomic analysis of surveillance data. LANCET MICROBE 2020; 1:e154-e164. [PMID: 33005903 DOI: 10.1016/s2666-5247(20)30059-8] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Background The number of cases of gonorrhoea in the USA and worldwide caused by Neisseria gonorrhoeae is increasing (555 608 reported US cases in 2017, and 87 million cases worldwide in 2016). Many countries report declining in vitro susceptibility of azithromycin, which is a concern because azithromycin and ceftriaxone are the recommended dual treatment in many countries. We aimed to identify strain types associated with decreased susceptibility to azithromycin. Methods We did a genomic analysis of N gonorrhoeae isolates obtained by the US Gonococcal Isolate Surveillance Project. Isolates were whole-genome sequenced based on decreased susceptibility to azithromycin (minimal inhibitory concentration [MIC] ≥2 μg/mL, using agar dilution antibiotic susceptibility testing) and geographical representation. Bioinformatic analyses established genomic diversity, strain population dynamics, and antimicrobial resistance profiles. Findings 410 isolates were sorted into more than 20 unique phylogenetic clades. One predominant persistent clade (consisting of 97 isolates) included the most isolates with azithromycin MICs of 2 μg/mL or higher (61 of 97 [63%] vs 59 of 311 [19%]; p<0·0001) and carried a mosaic mtr (multiple transferable resistance) locus (68 of 97 [70%] vs two of 313 [1%]; p<0·0001). Of the remaining 313 isolates, 57 (18%) had decreased susceptibility to azithromycin (MIC ≥4 μg/mL), which was attributed to 23S rRNA variants (56 of 57 [98%]) and formed phylogenetically diverse clades, showing various levels of clonal expansion. Interpretation Reduced azithromycin susceptibility was associated with expanding and persistent clades harbouring two well described resistance mechanisms, mosaic mtr locus and 23S rRNA variants. Understanding the role of recombination, particularly within the mtr locus, on the fitness and expansion of strains with decreased susceptibility has important implications for the public health response to minimise gonorrhoea transmission. Funding US Centers for Disease Control and Prevention (CDC), CDC Combating Antibiotic Resistant Bacteria initiative, Oak Ridge Institute for Science Education, US Department of Energy/CDC/Emory University, National Institutes of Health, and Biomedical Laboratory Research and Development Service of the US Department of Veterans Affairs.
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Affiliation(s)
- Kim M Gernert
- Laboratory Reference and Research Branch (K M Gernert PhD, S Seby MS, M W Schmerer PhD, J C Thomas IV PhD, C D Pham PhD, B H Raphael PhD, E N Kersh PhD), Surveillance and Data Management Branch (S St Cyr MD, H Weinstock PhD), and Epidemiology and Statistics Branch (K Schlanger PhD), Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA; Oak Ridge Institute for Science and Education Research Participation and Fellowship Program, Oak Ridge, TN, USA (S Seby, J C Thomas IV); Department of Microbiology and Immunology and Emory Antibiotic Resistance Center, Emory University School of Medicine, Atlanta, GA, USA (W M Shafer PhD); and Laboratories of Bacterial Pathogenesis, Veterans Affairs Medical Center, Decatur, GA, USA (W M Shafer)
| | - Sandra Seby
- Laboratory Reference and Research Branch (K M Gernert PhD, S Seby MS, M W Schmerer PhD, J C Thomas IV PhD, C D Pham PhD, B H Raphael PhD, E N Kersh PhD), Surveillance and Data Management Branch (S St Cyr MD, H Weinstock PhD), and Epidemiology and Statistics Branch (K Schlanger PhD), Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA; Oak Ridge Institute for Science and Education Research Participation and Fellowship Program, Oak Ridge, TN, USA (S Seby, J C Thomas IV); Department of Microbiology and Immunology and Emory Antibiotic Resistance Center, Emory University School of Medicine, Atlanta, GA, USA (W M Shafer PhD); and Laboratories of Bacterial Pathogenesis, Veterans Affairs Medical Center, Decatur, GA, USA (W M Shafer)
| | - Matthew W Schmerer
- Laboratory Reference and Research Branch (K M Gernert PhD, S Seby MS, M W Schmerer PhD, J C Thomas IV PhD, C D Pham PhD, B H Raphael PhD, E N Kersh PhD), Surveillance and Data Management Branch (S St Cyr MD, H Weinstock PhD), and Epidemiology and Statistics Branch (K Schlanger PhD), Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA; Oak Ridge Institute for Science and Education Research Participation and Fellowship Program, Oak Ridge, TN, USA (S Seby, J C Thomas IV); Department of Microbiology and Immunology and Emory Antibiotic Resistance Center, Emory University School of Medicine, Atlanta, GA, USA (W M Shafer PhD); and Laboratories of Bacterial Pathogenesis, Veterans Affairs Medical Center, Decatur, GA, USA (W M Shafer)
| | - Jesse C Thomas
- Laboratory Reference and Research Branch (K M Gernert PhD, S Seby MS, M W Schmerer PhD, J C Thomas IV PhD, C D Pham PhD, B H Raphael PhD, E N Kersh PhD), Surveillance and Data Management Branch (S St Cyr MD, H Weinstock PhD), and Epidemiology and Statistics Branch (K Schlanger PhD), Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA; Oak Ridge Institute for Science and Education Research Participation and Fellowship Program, Oak Ridge, TN, USA (S Seby, J C Thomas IV); Department of Microbiology and Immunology and Emory Antibiotic Resistance Center, Emory University School of Medicine, Atlanta, GA, USA (W M Shafer PhD); and Laboratories of Bacterial Pathogenesis, Veterans Affairs Medical Center, Decatur, GA, USA (W M Shafer)
| | - Cau D Pham
- Laboratory Reference and Research Branch (K M Gernert PhD, S Seby MS, M W Schmerer PhD, J C Thomas IV PhD, C D Pham PhD, B H Raphael PhD, E N Kersh PhD), Surveillance and Data Management Branch (S St Cyr MD, H Weinstock PhD), and Epidemiology and Statistics Branch (K Schlanger PhD), Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA; Oak Ridge Institute for Science and Education Research Participation and Fellowship Program, Oak Ridge, TN, USA (S Seby, J C Thomas IV); Department of Microbiology and Immunology and Emory Antibiotic Resistance Center, Emory University School of Medicine, Atlanta, GA, USA (W M Shafer PhD); and Laboratories of Bacterial Pathogenesis, Veterans Affairs Medical Center, Decatur, GA, USA (W M Shafer)
| | - Sancta St Cyr
- Laboratory Reference and Research Branch (K M Gernert PhD, S Seby MS, M W Schmerer PhD, J C Thomas IV PhD, C D Pham PhD, B H Raphael PhD, E N Kersh PhD), Surveillance and Data Management Branch (S St Cyr MD, H Weinstock PhD), and Epidemiology and Statistics Branch (K Schlanger PhD), Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA; Oak Ridge Institute for Science and Education Research Participation and Fellowship Program, Oak Ridge, TN, USA (S Seby, J C Thomas IV); Department of Microbiology and Immunology and Emory Antibiotic Resistance Center, Emory University School of Medicine, Atlanta, GA, USA (W M Shafer PhD); and Laboratories of Bacterial Pathogenesis, Veterans Affairs Medical Center, Decatur, GA, USA (W M Shafer)
| | - Karen Schlanger
- Laboratory Reference and Research Branch (K M Gernert PhD, S Seby MS, M W Schmerer PhD, J C Thomas IV PhD, C D Pham PhD, B H Raphael PhD, E N Kersh PhD), Surveillance and Data Management Branch (S St Cyr MD, H Weinstock PhD), and Epidemiology and Statistics Branch (K Schlanger PhD), Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA; Oak Ridge Institute for Science and Education Research Participation and Fellowship Program, Oak Ridge, TN, USA (S Seby, J C Thomas IV); Department of Microbiology and Immunology and Emory Antibiotic Resistance Center, Emory University School of Medicine, Atlanta, GA, USA (W M Shafer PhD); and Laboratories of Bacterial Pathogenesis, Veterans Affairs Medical Center, Decatur, GA, USA (W M Shafer)
| | - Hillard Weinstock
- Laboratory Reference and Research Branch (K M Gernert PhD, S Seby MS, M W Schmerer PhD, J C Thomas IV PhD, C D Pham PhD, B H Raphael PhD, E N Kersh PhD), Surveillance and Data Management Branch (S St Cyr MD, H Weinstock PhD), and Epidemiology and Statistics Branch (K Schlanger PhD), Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA; Oak Ridge Institute for Science and Education Research Participation and Fellowship Program, Oak Ridge, TN, USA (S Seby, J C Thomas IV); Department of Microbiology and Immunology and Emory Antibiotic Resistance Center, Emory University School of Medicine, Atlanta, GA, USA (W M Shafer PhD); and Laboratories of Bacterial Pathogenesis, Veterans Affairs Medical Center, Decatur, GA, USA (W M Shafer)
| | - William M Shafer
- Laboratory Reference and Research Branch (K M Gernert PhD, S Seby MS, M W Schmerer PhD, J C Thomas IV PhD, C D Pham PhD, B H Raphael PhD, E N Kersh PhD), Surveillance and Data Management Branch (S St Cyr MD, H Weinstock PhD), and Epidemiology and Statistics Branch (K Schlanger PhD), Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA; Oak Ridge Institute for Science and Education Research Participation and Fellowship Program, Oak Ridge, TN, USA (S Seby, J C Thomas IV); Department of Microbiology and Immunology and Emory Antibiotic Resistance Center, Emory University School of Medicine, Atlanta, GA, USA (W M Shafer PhD); and Laboratories of Bacterial Pathogenesis, Veterans Affairs Medical Center, Decatur, GA, USA (W M Shafer)
| | - Brian H Raphael
- Laboratory Reference and Research Branch (K M Gernert PhD, S Seby MS, M W Schmerer PhD, J C Thomas IV PhD, C D Pham PhD, B H Raphael PhD, E N Kersh PhD), Surveillance and Data Management Branch (S St Cyr MD, H Weinstock PhD), and Epidemiology and Statistics Branch (K Schlanger PhD), Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA; Oak Ridge Institute for Science and Education Research Participation and Fellowship Program, Oak Ridge, TN, USA (S Seby, J C Thomas IV); Department of Microbiology and Immunology and Emory Antibiotic Resistance Center, Emory University School of Medicine, Atlanta, GA, USA (W M Shafer PhD); and Laboratories of Bacterial Pathogenesis, Veterans Affairs Medical Center, Decatur, GA, USA (W M Shafer)
| | - Ellen N Kersh
- Laboratory Reference and Research Branch (K M Gernert PhD, S Seby MS, M W Schmerer PhD, J C Thomas IV PhD, C D Pham PhD, B H Raphael PhD, E N Kersh PhD), Surveillance and Data Management Branch (S St Cyr MD, H Weinstock PhD), and Epidemiology and Statistics Branch (K Schlanger PhD), Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA; Oak Ridge Institute for Science and Education Research Participation and Fellowship Program, Oak Ridge, TN, USA (S Seby, J C Thomas IV); Department of Microbiology and Immunology and Emory Antibiotic Resistance Center, Emory University School of Medicine, Atlanta, GA, USA (W M Shafer PhD); and Laboratories of Bacterial Pathogenesis, Veterans Affairs Medical Center, Decatur, GA, USA (W M Shafer)
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Kenyon C, Manoharan-Basil SS, Van Dijck C. Gonococcal resistance can be viewed productively as part of a syndemic of antimicrobial resistance: an ecological analysis of 30 European countries. Antimicrob Resist Infect Control 2020; 9:97. [PMID: 32605597 PMCID: PMC7325135 DOI: 10.1186/s13756-020-00764-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 06/23/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND It is unclear how important bystander selection is in the genesis of antimicrobial resistance (AMR) in Neisseria gonorrhoeae. METHODS We assessed bystander selection in a novel way. Mixed-effects linear regression was used to assess if country-level prevalence of gonococcal AMR in 30 European countries predicts homologous AMR in other bacteria. The data used was from the European Antimicrobial Resistance Surveillance Network. RESULTS The prevalence of gonococcal ciprofloxacin resistance was found to be positively associated with AMR prevalence in E. coli (coef. 0.52; P = 0.007), Acinetobacter spp. (coef. 0.13; P = 0.044) and Pseudomonas aeruginosa (coef. 0.36; P = 0.020) but not Klebsiella pneumoniae. Azithromycin resistance in N. gonorrhoeae was positively associated with macrolide resistance in Streptococcus pneumoniae (coef. 0.01; P = 0.018). No association was found for cephalosporins. CONCLUSIONS Gonococcal AMR is linked to that in other bacteria. This finding is likely explained by high antimicrobial consumption in affected populations and provides additional motivation for strengthening antimicrobial stewardship programs.
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Affiliation(s)
- Chris Kenyon
- HIV/STI Unit, Institute of Tropical Medicine, 2000, Antwerp, Belgium. .,Division of Infectious Diseases and HIV Medicine, University of Cape Town, Anzio Road, Observatory, Cape Town, 7700, South Africa.
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21
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Abstract
INTRODUCTION Point-of-care (POC) tests for Neisseria gonorrhoeae (Ng) are urgently needed to control the gonorrhea epidemic, so patients can receive immediate diagnoses and treatment. While the advent of nucleic acid amplification tests (NAATs) has improved the accuracy of Ng identification, very few POC assays are able to provide results of such tests at the clinical visit. Additionally, antimicrobial resistance (AMR) presents a unique treatment challenge for Ng. AREAS COVERED This review notes that older POC tests have lower sensitivity for Ng, compared to the currently-available NAATs, and are not adequate for the current demand for high sensitivity. Promising newer assays, which can be used at the POC are covered. This review also includes data about clinicians' and patients' acceptability and expectations of POC tests for Ng, testing of extragenital specimens, pooling studies, as well as their impact clinically, and use in low-resource settings. EXPERT OPINION The ability to use POC tests to identify and immediately treat Ng infections at the patient encounter offers many benefits and opportunities. POC tests for Ng are currently available, but not widely used especially in low-resource settings. Further development of POC tests with AMR testing capacity is needed to help guide antimicrobial stewardship.
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Affiliation(s)
- Charlotte A Gaydos
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University , Baltimore, Maryland, USA
| | - Johan H Melendez
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University , Baltimore, Maryland, USA
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22
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Tien V, Punjabi C, Holubar MK. Antimicrobial resistance in sexually transmitted infections. J Travel Med 2020; 27:5678669. [PMID: 31840758 DOI: 10.1093/jtm/taz101] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 12/06/2019] [Accepted: 12/11/2019] [Indexed: 12/13/2022]
Abstract
RATIONALE FOR REVIEW International travel facilitates the spread of drug-resistant infections, including sexually transmitted infections (STIs). In 2016, the World Health Organization highlighted the global burden of 'curable' STIs, estimating 376 million new infections of gonorrhoea, chlamydia, syphilis and trichomoniasis annually, with considerable geographic variation in both the burden of disease and prevalence of resistance. Travelers' risk of contracting and transmitting drug-resistant STIs depends in part on their geographic exposure. In this review, we describe the epidemiology of antimicrobial resistance (AMR) and the management of these four common STIs and Mycoplasma genitalium, an increasingly recognized cause of non-gonococcal urethritis. KEY FINDINGS Multi-drug and extensively drug resistant gonorrhoea strains have been associated with international spread, particularly in travelers returning from Southeast Asia. Chlamydia is the most common bacterial STI worldwide. Although in vitro resistance has been reported, surveillance data suggest that clinically significant resistance to macrolides and tetracyclines is rare. Macrolide resistance in syphilis is now endemic in much of the world but there is no documented penicillin resistance, which remains first-line therapy. Trichomoniasis is the most common non-viral STI worldwide. Although clinical failure after treatment occurs, resistance to metronidazole is thought to be uncommon. Mycoplasma genitalium exhibits intrinsic resistance to many antibiotics, and the prevalence of resistance to both first- and second-line regimens (macrolides and fluoroquinolones) is increasing worldwide, with limited alternative therapeutic options. RECOMMENDATIONS International travelers are at risk for acquiring resistant STIs with limited therapeutic options. Improved diagnostics are urgently needed to improve AMR surveillance and the management of infected patients. As no vaccinations are currently available for these STIs, and pre-exposure prophylaxis is an area of active study with limited data, condom use is critical for prevention. Travel medicine providers should incorporate STI risk reduction counselling, with an emphasis on condom use, into the routine pre-travel consultation.
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Affiliation(s)
- Vivian Tien
- Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Chitra Punjabi
- Department of Medicine, Division of Infectious Diseases, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Marisa K Holubar
- Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, CA, USA
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Variability in Azithromycin Susceptibility Results for Neisseria gonorrhoeae Obtained Using Gradient MIC Strip and Agar Dilution Techniques. J Clin Microbiol 2019; 57:JCM.01353-19. [PMID: 31578264 DOI: 10.1128/jcm.01353-19] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 09/29/2019] [Indexed: 12/29/2022] Open
Abstract
Azithromycin is a component of empirical treatment regimens for Neisseria gonorrhoeae infections, but antimicrobial susceptibility testing for this agent is technically challenging. We compared the intertest variability, MIC values, and CLSI/EUCAST categorization of clinical and reference isolates of N. gonorrhoeae treated with azithromycin by testing 107 clinical isolates and nine reference isolates by agar dilution and in duplicates using MIC test strips (Liofilchem, Italy) and Etests (bioMérieux, France). Replicate isolate agreement within 1 log2 between duplicate tests was 87% for MIC test strips and 100% for Etests (P < 0.001). Essential agreement with the agar dilution method was higher for Etests (91%) than for MIC test strips (44%, P < 0.001). The geometric mean MIC was highest for MIC test strips (0.8 mg/liter) and significantly higher than both Etest (0.47 mg/liter, P < 0.001) and agar dilution (0.26 mg/liter, P < 0.001) methods. Etest MICs were higher than those obtained with agar dilution (P < 0.001). Agar dilution, MIC test strip, and Etest methods categorized 96%, 85%, and 95% (P = 0.003) of clinical isolates, respectively, as susceptible/wild type according to CLSI/EUCAST criteria. Our results illustrate the difficulties underlying azithromycin susceptibility testing for N. gonorrhoeae and demonstrate that results can vary using different methods. This variability could influence antimicrobial resistance reporting between laboratories involved in N. gonorrhoeae surveillance programs.
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24
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Fletcher-Lartey S, Dronavalli M, Alexander K, Ghosh S, Boonwaat L, Thomas J, Robinson A, Patel Z, Forssman B, Pal N. Trends in Antimicrobial Resistance Patterns in Neisseria Gonorrhoeae in Australia and New Zealand: A Meta-analysis and Systematic Review. Antibiotics (Basel) 2019; 8:E191. [PMID: 31652729 PMCID: PMC6963718 DOI: 10.3390/antibiotics8040191] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 10/14/2019] [Accepted: 10/22/2019] [Indexed: 02/07/2023] Open
Abstract
(1) Background: The widespread development of resistance among Neisseria gonorrhoeae (NG) clinical isolates has been reported by surveillance systems around the world. This meta-analysis estimated the changes in susceptibility patterns among antibiotics under surveillance in Australia and New Zealand. (2) Methods: Articles published in English from 1980-2018, from Australia or New Zealand, that met the selection criteria were included. The meta-analysis was carried out using the R statistical software. (3) Results: In Australia, there has been decreasing susceptibility of gonococcal isolates to selected antimicrobials over time. Azithromycin (Odds Ratio (OR): 0.73; 95% Confidence Interval (CI) 0.64-0.82) and ceftriaxone (OR: 0.69; 95% CI 0.59-0.80) showed decreasing levels of susceptibility each year. Western Australia (OR: 0.76; 95% CI 0.60-0.96) and Victoria (OR: 0.74; 95% CI 0.60-0.90) also had decreasing levels of susceptibility to ceftriaxone over time compared with other states and territories. (4) Conclusions: The results highlight the need for the development of new approaches for managing cases of gonorrhoea. Improved antimicrobial stewardship, enhanced surveillance and contact tracing are needed to identify and respond to changes in antibiotic resistance in a timely manner. Increasing awareness and public health follow-up of cases can help to interrupt the cycle of infection and limit transmission.
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Affiliation(s)
| | - Mithilesh Dronavalli
- Public Health Unit, South Western Sydney Local Health District, Liverpool, NSW 2170, Australia.
| | - Kate Alexander
- Public Health Unit, South Western Sydney Local Health District, Liverpool, NSW 2170, Australia.
| | - Sayontonee Ghosh
- Public Health Unit, South Western Sydney Local Health District, Liverpool, NSW 2170, Australia.
| | - Leng Boonwaat
- Public Health Unit, South Western Sydney Local Health District, Liverpool, NSW 2170, Australia.
| | - Jane Thomas
- Public Health Unit, Nepean Blue Mountains Local Health District, Penrith, NSW 2750, Australia.
| | - Amanda Robinson
- Public Health Unit, Nepean Blue Mountains Local Health District, Penrith, NSW 2750, Australia.
| | - Zeel Patel
- Public Health Unit, South Western Sydney Local Health District, Liverpool, NSW 2170, Australia.
| | - Bradley Forssman
- Public Health Unit, Nepean Blue Mountains Local Health District, Penrith, NSW 2750, Australia.
| | - Naru Pal
- Public Health Unit, South Western Sydney Local Health District, Liverpool, NSW 2170, Australia.
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Trends and Risk Factors for Antimicrobial-Resistant Neisseria gonorrhoeae, Melbourne, Australia, 2007 to 2018. Antimicrob Agents Chemother 2019; 63:AAC.01221-19. [PMID: 31383663 PMCID: PMC6761556 DOI: 10.1128/aac.01221-19] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Accepted: 07/30/2019] [Indexed: 01/19/2023] Open
Abstract
Antimicrobial resistance (AMR) in Neisseria gonorrhoeae is a major public health problem. Traditionally, AMR surveillance programs for N. gonorrhoeae have focused mainly on laboratory data to describe the prevalence and trends of resistance. However, integrating individual-level risk factors (e.g., sexual orientation or international travel) with laboratory data provides important insights into factors promoting the spread of resistant N. gonorrhoeae. Antimicrobial resistance (AMR) in Neisseria gonorrhoeae is a major public health problem. Traditionally, AMR surveillance programs for N. gonorrhoeae have focused mainly on laboratory data to describe the prevalence and trends of resistance. However, integrating individual-level risk factors (e.g., sexual orientation or international travel) with laboratory data provides important insights into factors promoting the spread of resistant N. gonorrhoeae. Here, over a 12-year period, we assessed the trends and risk factors for resistant N. gonorrhoeae in individuals attending a large publicly funded sexual health center in Melbourne, Australia. A total of 7,588 N. gonorrhoeae isolates were cultured from 5,593 individuals between 1 January 2007 and 31 December 2018. The proportion of isolates with penicillin resistance decreased from 49.5% in 2007 to 18.3% in 2018 (ptrend < 0.001) and from 63.5% in 2007 to 21.1% in 2018 for ciprofloxacin resistance (ptrend < 0.001). In contrast, the proportion of isolates displaying decreased susceptibility to ceftriaxone increased from 0.5% in 2007 to 2.9% in 2018 (ptrend < 0.001), with a significant increase in low-level azithromycin resistance, from 2.5% in 2012 to 8.2% in 2018 (ptrend < 0.001). Multivariate analysis identified risk factors for multidrug-resistant (MDR) N. gonorrhoeae, namely, female sex and country of birth, with MDR isolates more common in individuals born in northeast Asia, further highlighting the importance of this region and international travel as factors in the cross-border transmission of MDR N. gonorrhoeae. Future surveillance work should incorporate additional epidemiological and genomic data to provide a comprehensive overview of the emergence and spread of resistant N. gonorrhoeae.
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Unemo M, Lahra MM, Cole M, Galarza P, Ndowa F, Martin I, Dillon JAR, Ramon-Pardo P, Bolan G, Wi T. World Health Organization Global Gonococcal Antimicrobial Surveillance Program (WHO GASP): review of new data and evidence to inform international collaborative actions and research efforts. Sex Health 2019; 16:412-425. [PMID: 31437420 PMCID: PMC7035961 DOI: 10.1071/sh19023] [Citation(s) in RCA: 145] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 05/29/2019] [Indexed: 12/21/2022]
Abstract
Antimicrobial resistance (AMR) in Neisseria gonorrhoeae is a serious public health problem, compromising the management and control of gonorrhoea globally. Resistance in N. gonorrhoeae to ceftriaxone, the last option for first-line empirical monotherapy of gonorrhoea, has been reported from many countries globally, and sporadic failures to cure especially pharyngeal gonorrhoea with ceftriaxone monotherapy and dual antimicrobial therapies (ceftriaxone plus azithromycin or doxycycline) have been confirmed in several countries. In 2018, the first gonococcal isolates with ceftriaxone resistance plus high-level azithromycin resistance were identified in England and Australia. The World Health Organization (WHO) Global Gonococcal Antimicrobial Surveillance Program (GASP) is essential to monitor AMR trends, identify emerging AMR and provide evidence for refinements of treatment guidelines and public health policy globally. Herein we describe the WHO GASP data from 67 countries in 2015-16, confirmed gonorrhoea treatment failures with ceftriaxone with or without azithromycin or doxycycline, and international collaborative actions and research efforts essential for the effective management and control of gonorrhoea. In most countries, resistance to ciprofloxacin is exceedingly high, azithromycin resistance is present and decreased susceptibility or resistance to ceftriaxone has emerged. Enhanced global collaborative actions are crucial for the control of gonorrhoea, including improved prevention, early diagnosis, treatment of index patient and partner (including test-of-cure), improved and expanded AMR surveillance (including surveillance of antimicrobial use and treatment failures), increased knowledge of correct antimicrobial use and the pharmacokinetics and pharmacodynamics of antimicrobials and effective drug regulations and prescription policies (including antimicrobial stewardship). Ultimately, rapid, accurate and affordable point-of-care diagnostic tests (ideally also predicting AMR and/or susceptibility), new therapeutic antimicrobials and, the only sustainable solution, gonococcal vaccine(s) are imperative.
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Affiliation(s)
- Magnus Unemo
- World Health Organization Collaborating Centre for Gonorrhoea and Other STIs, Department of Laboratory Medicine, Faculty of Medicine and Health, Örebro University, SE-701 85 Örebro, Sweden; and Corresponding author.
| | - Monica M Lahra
- World Health Organization Collaborating Centre for Sexually Transmitted Infections and Antimicrobial Resistance, New South Wales Health Pathology, Microbiology, Randwick, NSW, Australia
| | - Michelle Cole
- National Infection Service, Public Health England, London, UK
| | - Patricia Galarza
- National Reference Laboratory for STDs, National Institute of Infectious Diseases - ANLIS 'Dr Carlos G. Malbrán', Buenos Aires, Argentina
| | - Francis Ndowa
- Skin and Genitourinary Medicine Clinic, Harare, Zimbabwe
| | - Irene Martin
- Public Health Agency of Canada, National Microbiology Laboratory, Winnipeg, MB, Canada
| | | | - Pilar Ramon-Pardo
- Communicable Diseases and Environmental Determinants of Health Department Pan American Health Organization/World Health Organization, Washington, DC, USA
| | - Gail Bolan
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Teodora Wi
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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