Gonorrhea infections in China are showing decreasing susceptibility to ceftriaxone along with high levels of resistance to other antibiotics, according to a study today in the Journal of Infectious Diseases.
To evaluate resistance trends in Neisseria gonorrhoeae infections in China, a team of Chinese researchers analyzed 463 isolates collected from Chinese men and women in 2021. They tested susceptibility to azithromycin, spectinomycin, penicillin, tetracycline, ciprofloxacin, ceftriaxone, and cefixime and conducted whole-genome sequencing (WGS) to assess resistance markers and sequence types.
High resistance to penicillin (75.2%), tetracycline (89.7%), and ciprofloxacin (98.3%) and decreased susceptibility to ceftriaxone (8.9%), cefixime (14.3%), and azithromycin (8.6%) were observed among the isolates. WGS revealed that sustained transmission of clones of a global N gonorrhoeae strain (FC428) that harbors mutations in the penA-60.001 gene appears to be driving resistance to ceftriaxone, which is the last remaining recommended first-line gonorrhea treatment in China and many other countries.
The sustained dissemination of multidrug-resistant penA-60.001 subclones in China in 2021 possibly threatens the effectiveness of ceftriaxone.
The study authors say the decreased susceptibility to ceftriaxone and cefixime (an oral antibiotic with similar in vitro activity to ceftriaxone) far exceeds what's been observed in other countries. Furthermore, they note, the high-level resistance to penicillin, tetracycline, and ciprofloxacin suggests those antibiotics should no longer be considered for first-line treatment.
"The sustained dissemination of multidrug-resistant penA-60.001 subclones in China in 2021 possibly threatens the effectiveness of ceftriaxone monotherapy," they write. "The strengthening of gonococcal surveillance in China would help quantify the true burden of the penA-60.001 mosaic strain, which also plays an important role in the development of prevention and control measures."