Case-series of ceftriaxone-resistant Neisseria gonorrhoeae infections detected in England
Updated 4 September 2024
Applies to England
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Main points
There were 15 new confirmed cases of infection with ceftriaxone-resistant Neisseria gonorrhoeae, including 5 which were extensively drug-resistant, detected in England between June 2022 and May 2024.
Since the first case detected in England in 2015, there have now been a total of 31 ceftriaxone-resistant Neisseria gonorrhoeae cases, 7 of which were extensively drug-resistant.
The UK Health Security Agency (UKSHA) is reminding all sexual health services to culture gonococcal isolates, perform test-of-cure, and refer all ceftriaxone-resistant N. gonorrhoeae strains or potential strains or treatment failures to UKHSA.
Background
Gonorrhoea is the second most commonly diagnosed sexually transmitted infection (STI) in England and the highest annual number of diagnoses since records began was reported in 2023 (85,223). Neisseria gonorrhoeae, the bacteria which causes gonorrhoea, has developed resistance to every class of antibiotics used to treat it, and cephalosporins are the last remaining class of antibiotics available for use as empirical monotherapy. The currently recommended first-line therapy is 1g ceftriaxone (a cephalosporin) and, while the vast majority of gonorrhoea cases in England are susceptible to ceftriaxone, there are sporadic cases of infection with ceftriaxone-resistant N. gonorrhoeae detected in England.
Recent epidemiology
Following the previously reported 16 cases between 2015 and May 2022, a further 15 ceftriaxone-resistant N. gonorrhoeae infections were detected in England. Five of the 15 recent cases were extensively drug-resistant (XDR, resistant to both first- and second-line treatment options and to other antibiotics), compared to 2 XDR cases detected previously in England. All 31 cases detected in England to date, have been among heterosexual individuals, mostly in their 20s, and most acquired the infection in the Asia-Pacific region (the region with the highest prevalence of ceftriaxone-resistance globally).
Further phenotypic and phylogenetic characteristics have been provided in a preprint publication (1).
UKHSA has sent a clinical alert to sexual health services to reinforce the need to culture gonococcal isolates, perform test-of-cure, and refer all ceftriaxone-resistant N. gonorrhoeae strains or potential treatment failures to UKHSA. UKSHA is also recommending members of the public to use condoms consistently and correctly with new or casual partners.
Reference
1. Fifer H, Doumith M, Rubinstein L, Mitchell L, Wallis M, Singh S and others (2024). ‘Ceftriaxone-resistant Neisseria gonorrhoeae detected in England, 2015 to 2024; an observational study’. Medrxiv preprint (17 August).