You are here

  • Home
  • Online First
  • What are we missing? Data from the Gonorrhoea Undetected Resistance Laboratory Study (GURLS)

Article Text

Article menu
Download PDFPDF
Short report
What are we missing? Data from the Gonorrhoea Undetected Resistance Laboratory Study (GURLS)
  1. Michelle Jayne Cole1,
  2. Anna Vickers1,
  3. Suzy Sun1,
  4. Michaela Joanne Day1,
  5. Ross Harris1,
  6. Laura Burgess Tornaletti2,
  7. Katie Thorley1,
  8. Hussain Ahmed3,
  9. Monica Rebec4,
  10. Miriam O’Connor5,
  11. Soma N’Jai-Ndimbalan6,
  12. Alan Lord7,8,
  13. Mark Hopkins9,
  14. Paul Grant10,
  15. Peter Muir11,12,
  16. Kate Sibson13,
  17. Hamish Mohammed1,14,
  18. Katy Sinka1,
  19. Rachel Pitt-Kendall1,
  20. Helen Fifer1
  1. 1UK Health Security Agency, London, UK
  2. 2The University of Manchester Faculty of Biology Medicine and Health, Manchester, UK
  3. 3University Hospitals Birmingham NHS Foundation Trust, Birmingham, England, UK
  4. 4Infection and Immunity Laboratory, NHS North West London Pathology, London, UK
  5. 5Chelsea and Westminster Hospital NHS Foundation Trust, London, England, UK
  6. 6Guy's and St Thomas’ NHS Foundation Trust, London, England, UK
  7. 7Manchester University NHS Foundation Trust, Manchester, England, UK
  8. 8UK Health Security Agency, Manchester, England, UK
  9. 9Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
  10. 10Health Service Laboratories, London, UK
  11. 11Infection Sciences, North Bristol NHS Trust, Bristol, UK
  12. 12South West Regional Laboratory, UKHSA, Bristol, UK
  13. 13Leeds Teaching Hospitals NHS Trust, Leeds, England, UK
  14. 14The National Institute for Health Research Health Protection Research Unit in Blood Borne and Sexually Transmitted Infections at University College London in Partnership with the UK Health Security Agency, London, UK
  1. Correspondence to Dr Michelle Jayne Cole; michelle.cole{at}ukhsa.gov.uk

Abstract

Objectives Increasing ceftriaxone-resistant Neisseria gonorrhoeae is of public health concern. A cluster of ceftriaxone-resistant N. gonorrhoeae was identified in 2022, which was linked to heterosexuals from the Asia-Pacific region who were studying at UK universities. The possibility of further transmission within and beyond this network was of concern, particularly as not all gonococcal cases have a positive culture for antimicrobial susceptibility testing to be performed. We, therefore, undertook a case finding exercise using an N. gonorrhoeae penA real-time PCR to identify undetected transmission of ceftriaxone-resistant strains. The PCR detects penA-60.001, which is the most common gonococcal ceftriaxone-resistance mechanism. The aim of this Gonorrhoea Undetected Resistance Laboratory Study was to estimate the prevalence of undetected ceftriaxone-resistant N. gonorrhoeae in England.

Methods Sexually transmitted infection surveillance data (2017–2021) was combined with university data on student country of origin to identify sexual health services in English university towns with the highest number of gonorrhoea cases among those of Asian ethnicity born in selected countries of the Asia-Pacific region. Residual N. gonorrhoeae-positive molecular specimens from women (as a proxy for heterosexual behaviour) aged 18–30 years were sent to the UK Health Security Agency (UKHSA) for testing.

Results Between February 2023 and March 2024, 921 specimens meeting the inclusion criteria were received, of which 661 were reconfirmed as N. gonorrhoeae. Of these, one was positive on the penA PCR, indicating ceftriaxone resistance; this specimen came from a previously identified case, therefore no ‘undetected’ cases were identified.

Conclusions This case-finding exercise provided reassurance that ceftriaxone-resistant N. gonorrhoeae in England is currently adequately detected through the existing UKHSA-enhanced surveillance activities. The current penA PCR is a useful tool in the fight to keep gonorrhoea a treatable infection; however, it requires expansion as it does not currently detect all penA alleles responsible for ceftriaxone resistance.

  • NEISSERIA GONORRHOEAE
  • Drug Resistance, Bacterial
  • PUBLIC HEALTH

https://doi.org/10.1136/sextrans-2024-056459

Statistics from Altmetric.com

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

    View Full Text

    Footnotes

    • MJC and AV are joint first authors.

    • Handling editor Martí Vall-Mayans

    • Contributors SS, MD, RH, LBT, KT, HM, KS, RP and HF initiated and designed the study. HA, MR, MO'C, SN'J-N, AL, MH, PG, PM and KS provided specimens for inclusion in the project. MJC, AV, MD, RP were responsible for the UKHSA laboratory work. MJC, AV and RP performed the data analysis, with RH providing statistical expertise. MJC, AV, SS, RP and HF prepared the first draft of the manuscript. All authors reviewed and approved the final manuscript. MJC is the guarantor of the study.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors. The study was funded by UKHSA internal funding.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer-reviewed.