Antimicrobial resistance in Neisseria gonorrhoeae in nine sentinel countries within the World Health Organization Enhanced Gonococcal Antimicrobial Surveillance Programme (EGASP), 2023: a retrospective observational studyResearch in context
Summary: Background: The global spread of antimicrobial resistance (AMR) in Neisseria gonorrhoeae threatens empiric single-dose gonorrhoea treatment. Enhanced global AMR surveillance is imperative. We report i) gonococcal antimicrobial susceptibility and resistance data from 2023 in the World Healt...
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| author | Ismael Maatouk Phiona Vumbugwa Thitima Cherdtrakulkiat Lon Say Heng Irving Hoffman Noel Palaypayon Francis Kakooza Rossaphorn Kittiyaowamarn Peter Kyambadde Monica M. Lahra Pham Thi Lan Venessa Maseko Mitch Matoga Anna Machiha Etienne Müller Thuy Thi Phan Nguyen Le Huu Doanh Vichea Ouk Vivi Setiawaty Sonia B. Sia Teguh S. Hartono Mot Virak Nguyen Thi Thuy Van Magnus Unemo Teodora Wi Lon Say Heng Vichea Ouk Mot Virak Phal Kun Mom Serongkea Deng Vivi Setiawaty Endang Lukitosari Nurhalina Afriana Verawati Sulaiman Teguh S. Hartono Maria Laurensia Ni Luh Putu Pitawati Mitch Matoga Irving Hoffman Robert Krysiak Jane Chen Naomi Bonongwe Claightone Chirombo Edward Jere James Kapha Sonia B. Sia Manuel C. Jamoralin, Jr. Marietta Lagrada June Gayeta Jaywardeen Abad Noel Palaypayon Diana Lim Iftizar N. Haron Joseph Carlo Sangco Felyrose Fuertes August Cesar Abrajano Ruby Rusia-Uy Christine Ivy Paula S. Agtuca Ma. Theresa A. Fedoc-Minguito Louwela A. Jerusalem Venessa Maseko Etienne Müller Lindy Gumede Portia Baloyi Rossaphorn Kittiyaowamarn Natnaree Girdthep Porntip Paopang Pongsathorn Sangprasert Thitima Cherdtrakulkiat Jaray Tongtoyai Francis Kakooza Peter Kyambadde Emmanuel Mande Martha Nakasi Le Huu Doanh Pham Thi Lan Pham Quynh Hoa Pham Dieu Hoa Thuy Thi Phan Nguyen Hao Trong Nguyen Nhi Thi Uyen Pham Phuong Thi Thanh Nguyen Nguyen Thi Thuy Van Francis Slaughter Anna Machiha Owen Mugurungi Agnes Juru Tatenda Ngorima Lucia Sisya Kudzai Takarinda Andrew Tarupiwa Muchaneta Mugabe Mkhokheli Ngwenya Precious Paidamoyo Andifasi Monica Lahra Sebastian van Hal Magnus Unemo Daniel Golparian Susanne Jacobsson Daniel Schröder Teodora Wi Ismael Maatouk Phiona Vumbugwa |
| author_facet | Ismael Maatouk Phiona Vumbugwa Thitima Cherdtrakulkiat Lon Say Heng Irving Hoffman Noel Palaypayon Francis Kakooza Rossaphorn Kittiyaowamarn Peter Kyambadde Monica M. Lahra Pham Thi Lan Venessa Maseko Mitch Matoga Anna Machiha Etienne Müller Thuy Thi Phan Nguyen Le Huu Doanh Vichea Ouk Vivi Setiawaty Sonia B. Sia Teguh S. Hartono Mot Virak Nguyen Thi Thuy Van Magnus Unemo Teodora Wi Lon Say Heng Vichea Ouk Mot Virak Phal Kun Mom Serongkea Deng Vivi Setiawaty Endang Lukitosari Nurhalina Afriana Verawati Sulaiman Teguh S. Hartono Maria Laurensia Ni Luh Putu Pitawati Mitch Matoga Irving Hoffman Robert Krysiak Jane Chen Naomi Bonongwe Claightone Chirombo Edward Jere James Kapha Sonia B. Sia Manuel C. Jamoralin, Jr. Marietta Lagrada June Gayeta Jaywardeen Abad Noel Palaypayon Diana Lim Iftizar N. Haron Joseph Carlo Sangco Felyrose Fuertes August Cesar Abrajano Ruby Rusia-Uy Christine Ivy Paula S. Agtuca Ma. Theresa A. Fedoc-Minguito Louwela A. Jerusalem Venessa Maseko Etienne Müller Lindy Gumede Portia Baloyi Rossaphorn Kittiyaowamarn Natnaree Girdthep Porntip Paopang Pongsathorn Sangprasert Thitima Cherdtrakulkiat Jaray Tongtoyai Francis Kakooza Peter Kyambadde Emmanuel Mande Martha Nakasi Le Huu Doanh Pham Thi Lan Pham Quynh Hoa Pham Dieu Hoa Thuy Thi Phan Nguyen Hao Trong Nguyen Nhi Thi Uyen Pham Phuong Thi Thanh Nguyen Nguyen Thi Thuy Van Francis Slaughter Anna Machiha Owen Mugurungi Agnes Juru Tatenda Ngorima Lucia Sisya Kudzai Takarinda Andrew Tarupiwa Muchaneta Mugabe Mkhokheli Ngwenya Precious Paidamoyo Andifasi Monica Lahra Sebastian van Hal Magnus Unemo Daniel Golparian Susanne Jacobsson Daniel Schröder Teodora Wi Ismael Maatouk Phiona Vumbugwa |
| author_sort | Ismael Maatouk |
| collection | DOAJ |
| description | Summary: Background: The global spread of antimicrobial resistance (AMR) in Neisseria gonorrhoeae threatens empiric single-dose gonorrhoea treatment. Enhanced global AMR surveillance is imperative. We report i) gonococcal antimicrobial susceptibility and resistance data from 2023 in the World Health Organization Enhanced Gonococcal Antimicrobial Surveillance Programme (WHO EGASP) in the WHO Western Pacific Region (Cambodia, the Philippines, Viet Nam), Southeast Asian Region (Indonesia, Thailand), and African Region (Malawi, South Africa, Uganda, Zimbabwe), and ii) metadata of the gonorrhoea patients. Methods: In 2023, WHO EGASP included men with urethral discharge (n = 3498) and gonococcal isolates (n = 2491). Minimum inhibitory concentrations (MICs, mg/L) values were determined for ceftriaxone, cefixime, azithromycin, gentamicin, and ciprofloxacin using Etest (bioMérieux). Breakpoints from the European Committee on Antimicrobial Susceptibility Testing (EUCAST) were applied. Clinical and epidemiological variables associated with AMR isolates were assessed using univariable and multivariable logistic regression analyses of odds ratios. Findings: Overall, 3.8% (95% confidence interval (95% CI) 3.1–4.6%; 95/2487), 8.9% (95% CI 7.9–10.1%; 222/2484), 3.6% (95% CI 2.9–4.4%; 89/2487), and 95.3% (95% CI 93.2–97.5%; 1801/1890) of isolates were resistant to ceftriaxone, cefixime, azithromycin, and ciprofloxacin, respectively. All the ceftriaxone-resistant isolates were from Cambodia (15.3% (95% CI 11.5–20.1%), 42/274) and Viet Nam (20.4% (95% CI 15.9–25.7%), 53/260). In univariable analysis, ceftriaxone resistance was associated with travelling within the country during previous 30 days (OR 4.66, 95% CI 3.06–7.16; p < 0.001), and this association remained in multivariable analysis (aOR 4.12, 95% CI 2.65–6.65; p < 0.001). Interpretation: Resistance to ceftriaxone, cefixime, and azithromycin is a major global concern, and expanded and improved resistance surveillance is essential. The WHO EGASP has been substantially expanded in the recent years. Additionally, resistance breakpoints have been harmonised and test-of-cure, whole-genome sequencing, and extragenital sampling implemented, where feasible. Novel antimicrobials for gonorrhoea treatment are critical; zoliflodacin and gepotidacin are promising. Funding: WHO, Global Fund. |
| format | Article |
| id | doaj-art-ec05349933ad4004bbe3fb6524061a21 |
| institution | Kabale University |
| issn | 2666-6065 |
| language | English |
| publishDate | 2025-08-01 |
| publisher | Elsevier |
| record_format | Article |
| series | The Lancet Regional Health. Western Pacific |
| spelling | doaj-art-ec05349933ad4004bbe3fb6524061a212025-08-23T04:49:15ZengElsevierThe Lancet Regional Health. Western Pacific2666-60652025-08-016110166310.1016/j.lanwpc.2025.101663Antimicrobial resistance in Neisseria gonorrhoeae in nine sentinel countries within the World Health Organization Enhanced Gonococcal Antimicrobial Surveillance Programme (EGASP), 2023: a retrospective observational studyResearch in contextIsmael Maatouk0Phiona Vumbugwa1Thitima Cherdtrakulkiat2Lon Say Heng3Irving Hoffman4Noel Palaypayon5Francis Kakooza6Rossaphorn Kittiyaowamarn7Peter Kyambadde8Monica M. Lahra9Pham Thi Lan10Venessa Maseko11Mitch Matoga12Anna Machiha13Etienne Müller14Thuy Thi Phan Nguyen15Le Huu Doanh16Vichea Ouk17Vivi Setiawaty18Sonia B. Sia19Teguh S. Hartono20Mot Virak21Nguyen Thi Thuy Van22Magnus Unemo23Teodora Wi24Lon Say HengVichea OukMot VirakPhal Kun MomSerongkea DengVivi SetiawatyEndang LukitosariNurhalina AfrianaVerawati SulaimanTeguh S. HartonoMaria LaurensiaNi Luh Putu PitawatiMitch MatogaIrving HoffmanRobert KrysiakJane ChenNaomi BonongweClaightone ChiromboEdward JereJames KaphaSonia B. SiaManuel C. Jamoralin, Jr.Marietta LagradaJune GayetaJaywardeen AbadNoel PalaypayonDiana LimIftizar N. HaronJoseph Carlo SangcoFelyrose FuertesAugust Cesar AbrajanoRuby Rusia-UyChristine Ivy Paula S. AgtucaMa. Theresa A. Fedoc-MinguitoLouwela A. JerusalemVenessa MasekoEtienne MüllerLindy GumedePortia BaloyiRossaphorn KittiyaowamarnNatnaree GirdthepPorntip PaopangPongsathorn SangprasertThitima CherdtrakulkiatJaray TongtoyaiFrancis KakoozaPeter KyambaddeEmmanuel MandeMartha NakasiLe Huu DoanhPham Thi LanPham Quynh HoaPham Dieu HoaThuy Thi Phan NguyenHao Trong NguyenNhi Thi Uyen PhamPhuong Thi Thanh NguyenNguyen Thi Thuy VanFrancis SlaughterAnna MachihaOwen MugurungiAgnes JuruTatenda NgorimaLucia SisyaKudzai TakarindaAndrew TarupiwaMuchaneta MugabeMkhokheli NgwenyaPrecious Paidamoyo AndifasiMonica LahraSebastian van HalMagnus UnemoDaniel GolparianSusanne JacobssonDaniel SchröderTeodora WiIsmael MaatoukPhiona VumbugwaGlobal HIV, Hepatitis and STI Programmes, World Health Organization (WHO), Geneva, SwitzerlandGlobal HIV, Hepatitis and STI Programmes, World Health Organization (WHO), Geneva, SwitzerlandBangrak STIs Center, Division of AIDS and STIs, Department of Disease Control, Ministry of Public Health, Bangkok, ThailandNational Center for HIV/AIDS, Dermatology and Sexually Transmitted Diseases, Phnom Penh, CambodiaUniversity of North Carolina (UNC) Project Malawi, Lilongwe, MalawiDepartment of Health, Research Institute for Tropical Medicine, Manila, the PhilippinesInfectious Diseases Institute, Makerere University College of Health Sciences, Kampala, UgandaBangrak STIs Center, Division of AIDS and STIs, Department of Disease Control, Ministry of Public Health, Bangkok, ThailandSexually Transmitted Infections Program, Ministry of Health, Kampala, UgandaWHO Collaborating Centre for Sexually Transmitted Infections and Antimicrobial Resistance, New South Wales Health Pathology, Microbiology, Randwick, NSW, AustraliaNational Hospital of Dermatology and Venereology, and Hanoi Medical University, Viet NamCentre for HIV and STIs, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South AfricaUniversity of North Carolina (UNC) Project Malawi, Lilongwe, MalawiSexually Transmitted Infections, Ministry of Health, Harare, ZimbabweCentre for HIV and STIs, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South AfricaHo Chi Minh City Hospital of Dermatology and Venereology, Ho Chi Minh City, Viet NamNational Hospital of Dermatology and Venereology, and Hanoi Medical University, Viet NamNational Center for HIV/AIDS, Dermatology and Sexually Transmitted Diseases, Phnom Penh, CambodiaSulianti Saroso Infectious Disease Hospital, Jakarta, IndonesiaDepartment of Health, Research Institute for Tropical Medicine, Manila, the PhilippinesSulianti Saroso Infectious Disease Hospital, Jakarta, IndonesiaLaboratory of the National Institute of Public Health, Phnom Penh, CambodiaWHO Country Office, Hanoi, Viet NamWHO Collaborating Centre for Gonorrhoea and Other Sexually Transmitted Infections, Örebro University, Örebro, Sweden; University College London, London, United Kingdom; Corresponding author. WHO Collaborating Centre for Gonorrhoea and other Sexually Transmitted Infections, Department of Laboratory Medicine, Örebro University Hospital, Örebro, SE-701 85, Sweden.Global HIV, Hepatitis and STI Programmes, World Health Organization (WHO), Geneva, SwitzerlandSummary: Background: The global spread of antimicrobial resistance (AMR) in Neisseria gonorrhoeae threatens empiric single-dose gonorrhoea treatment. Enhanced global AMR surveillance is imperative. We report i) gonococcal antimicrobial susceptibility and resistance data from 2023 in the World Health Organization Enhanced Gonococcal Antimicrobial Surveillance Programme (WHO EGASP) in the WHO Western Pacific Region (Cambodia, the Philippines, Viet Nam), Southeast Asian Region (Indonesia, Thailand), and African Region (Malawi, South Africa, Uganda, Zimbabwe), and ii) metadata of the gonorrhoea patients. Methods: In 2023, WHO EGASP included men with urethral discharge (n = 3498) and gonococcal isolates (n = 2491). Minimum inhibitory concentrations (MICs, mg/L) values were determined for ceftriaxone, cefixime, azithromycin, gentamicin, and ciprofloxacin using Etest (bioMérieux). Breakpoints from the European Committee on Antimicrobial Susceptibility Testing (EUCAST) were applied. Clinical and epidemiological variables associated with AMR isolates were assessed using univariable and multivariable logistic regression analyses of odds ratios. Findings: Overall, 3.8% (95% confidence interval (95% CI) 3.1–4.6%; 95/2487), 8.9% (95% CI 7.9–10.1%; 222/2484), 3.6% (95% CI 2.9–4.4%; 89/2487), and 95.3% (95% CI 93.2–97.5%; 1801/1890) of isolates were resistant to ceftriaxone, cefixime, azithromycin, and ciprofloxacin, respectively. All the ceftriaxone-resistant isolates were from Cambodia (15.3% (95% CI 11.5–20.1%), 42/274) and Viet Nam (20.4% (95% CI 15.9–25.7%), 53/260). In univariable analysis, ceftriaxone resistance was associated with travelling within the country during previous 30 days (OR 4.66, 95% CI 3.06–7.16; p < 0.001), and this association remained in multivariable analysis (aOR 4.12, 95% CI 2.65–6.65; p < 0.001). Interpretation: Resistance to ceftriaxone, cefixime, and azithromycin is a major global concern, and expanded and improved resistance surveillance is essential. The WHO EGASP has been substantially expanded in the recent years. Additionally, resistance breakpoints have been harmonised and test-of-cure, whole-genome sequencing, and extragenital sampling implemented, where feasible. Novel antimicrobials for gonorrhoea treatment are critical; zoliflodacin and gepotidacin are promising. Funding: WHO, Global Fund.http://www.sciencedirect.com/science/article/pii/S2666606525002020Antimicrobial resistanceNeisseria gonorrhoeaeGonorrhoeaSurveillanceEnhanced Gonococcal Antimicrobial Surveillance Programme (EGASP) |
| spellingShingle | Ismael Maatouk Phiona Vumbugwa Thitima Cherdtrakulkiat Lon Say Heng Irving Hoffman Noel Palaypayon Francis Kakooza Rossaphorn Kittiyaowamarn Peter Kyambadde Monica M. Lahra Pham Thi Lan Venessa Maseko Mitch Matoga Anna Machiha Etienne Müller Thuy Thi Phan Nguyen Le Huu Doanh Vichea Ouk Vivi Setiawaty Sonia B. Sia Teguh S. Hartono Mot Virak Nguyen Thi Thuy Van Magnus Unemo Teodora Wi Lon Say Heng Vichea Ouk Mot Virak Phal Kun Mom Serongkea Deng Vivi Setiawaty Endang Lukitosari Nurhalina Afriana Verawati Sulaiman Teguh S. Hartono Maria Laurensia Ni Luh Putu Pitawati Mitch Matoga Irving Hoffman Robert Krysiak Jane Chen Naomi Bonongwe Claightone Chirombo Edward Jere James Kapha Sonia B. Sia Manuel C. Jamoralin, Jr. Marietta Lagrada June Gayeta Jaywardeen Abad Noel Palaypayon Diana Lim Iftizar N. Haron Joseph Carlo Sangco Felyrose Fuertes August Cesar Abrajano Ruby Rusia-Uy Christine Ivy Paula S. Agtuca Ma. Theresa A. Fedoc-Minguito Louwela A. Jerusalem Venessa Maseko Etienne Müller Lindy Gumede Portia Baloyi Rossaphorn Kittiyaowamarn Natnaree Girdthep Porntip Paopang Pongsathorn Sangprasert Thitima Cherdtrakulkiat Jaray Tongtoyai Francis Kakooza Peter Kyambadde Emmanuel Mande Martha Nakasi Le Huu Doanh Pham Thi Lan Pham Quynh Hoa Pham Dieu Hoa Thuy Thi Phan Nguyen Hao Trong Nguyen Nhi Thi Uyen Pham Phuong Thi Thanh Nguyen Nguyen Thi Thuy Van Francis Slaughter Anna Machiha Owen Mugurungi Agnes Juru Tatenda Ngorima Lucia Sisya Kudzai Takarinda Andrew Tarupiwa Muchaneta Mugabe Mkhokheli Ngwenya Precious Paidamoyo Andifasi Monica Lahra Sebastian van Hal Magnus Unemo Daniel Golparian Susanne Jacobsson Daniel Schröder Teodora Wi Ismael Maatouk Phiona Vumbugwa Antimicrobial resistance in Neisseria gonorrhoeae in nine sentinel countries within the World Health Organization Enhanced Gonococcal Antimicrobial Surveillance Programme (EGASP), 2023: a retrospective observational studyResearch in context The Lancet Regional Health. Western Pacific Antimicrobial resistance Neisseria gonorrhoeae Gonorrhoea Surveillance Enhanced Gonococcal Antimicrobial Surveillance Programme (EGASP) |
| title | Antimicrobial resistance in Neisseria gonorrhoeae in nine sentinel countries within the World Health Organization Enhanced Gonococcal Antimicrobial Surveillance Programme (EGASP), 2023: a retrospective observational studyResearch in context |
| title_full | Antimicrobial resistance in Neisseria gonorrhoeae in nine sentinel countries within the World Health Organization Enhanced Gonococcal Antimicrobial Surveillance Programme (EGASP), 2023: a retrospective observational studyResearch in context |
| title_fullStr | Antimicrobial resistance in Neisseria gonorrhoeae in nine sentinel countries within the World Health Organization Enhanced Gonococcal Antimicrobial Surveillance Programme (EGASP), 2023: a retrospective observational studyResearch in context |
| title_full_unstemmed | Antimicrobial resistance in Neisseria gonorrhoeae in nine sentinel countries within the World Health Organization Enhanced Gonococcal Antimicrobial Surveillance Programme (EGASP), 2023: a retrospective observational studyResearch in context |
| title_short | Antimicrobial resistance in Neisseria gonorrhoeae in nine sentinel countries within the World Health Organization Enhanced Gonococcal Antimicrobial Surveillance Programme (EGASP), 2023: a retrospective observational studyResearch in context |
| title_sort | antimicrobial resistance in neisseria gonorrhoeae in nine sentinel countries within the world health organization enhanced gonococcal antimicrobial surveillance programme egasp 2023 a retrospective observational studyresearch in context |
| topic | Antimicrobial resistance Neisseria gonorrhoeae Gonorrhoea Surveillance Enhanced Gonococcal Antimicrobial Surveillance Programme (EGASP) |
| url | http://www.sciencedirect.com/science/article/pii/S2666606525002020 |
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