Surveillance data on gonococcal antimicrobial susceptibility across Europe from the European Centre for Disease Prevention and Control (ECDC) show a high level of tetracycline resistance (58.4% of isolates), suggesting that doxycycline post-exposure prophylaxis (doxy PEP) is unlikely to reduce the region's rate of the sexually transmitted infection.

In 2023, as in every year since 2009, the European Gonococcal Antimicrobial Surveillance Programme (Euro-GASP) asked participating labs to collect gonococcal isolates from September to November. 

Researchers tested all isolates for susceptibility to the antibiotics ceftriaxone, cefixime, azithromycin, and ciprofloxacin and tested for beta-lactamase production to detect high-level resistance to penicillin. Data on resistance to tetracycline was also collected to track the effects of doxy-PEP in Europe. 

High-dose ceftriaxone alone or with azithromycin

Twenty-four European Union/European Economic Area (EU/EEA) member states participated in Euro-GASP, submitting 5,269 isolates to the European Surveillance System, 3,184 of which were included in the report. 

The European gonorrhoea treatment guideline recommends high-dose ceftriaxone plus azithromycin dual therapy or ceftriaxone high-dose monotherapy.

Most specimens (82.6%) were from males, and patient ages ranged from younger than 1 year to 82 years (median, 30 years). Most specimens were collected from the genitals (73.6%), followed by the rectum (14.9%) and throat (9.3%). Samples were also collected from the eye (0.7%), blood (0.2%), joint fluid (0.1%), and cerebrospinal fluid (0.03%).

Among the 59.3% of patients with known transmission route and data on sex (59.3%), 53.4% were female or heterosexual males, and 46.6% were men who have sex with men (MSM). Of the 24.7% with data on prior gonorrhea diagnoses, 33.3% had previously been infected. 

A total of 9.7% of 31.2% patients with known HIV status had HIV. Of patients with a known route of gonorrhea transmission, 97.6% were MSM, and 7.6% of the 34.2% of patients with information on likely country of transmission were probably infected outside of the reporting country. 

"The high level of tetracycline resistance suggests that doxy-PEP is unlikely to reduce the incidence of gonorrhoea across the EU/EEA," the ECDC wrote. "Therefore, the European gonorrhoea treatment guideline recommends high-dose ceftriaxone plus azithromycin dual therapy or ceftriaxone high-dose monotherapy."

Biotechnology company Peptilogics announced today that it has completed a $78 million financing round to support a phase 2/3 trial of its investigational treatment for prosthetic joint infections (PJIs).

The upcoming randomized controlled trial will enroll 240 patients beginning in December to determine whether zaloganan, an antibacterial and antibiofilm peptide developed by the Pittsburgh-based company, is superior to the current standard of care for PJIs in reducing clinical failure rates. The trial will also evaluate hospitalization duration, readmission rates, and the need for additional surgical procedures. Failure rates for current approaches range from 15% to 50%.

An estimated 45,000 PJI cases occur in the United States each year, and more are expected as the population ages and the number of knee and hip replacements rises. 

Drug targets biofilms

Zaloganan works by targeting and disrupting bacterial membranes and has demonstrated broad-spectrum activity against a wide range of pathogens. In a phase 1 trial in patients with PJIs, which are mediated by biofilms from the causative pathogens that grow on implanted hardware, 13 of 14 patients who received zaloganan irrigation during debridement, antibiotics, and implant retention procedures remained infection-free at 12 months.

"Biofilm is the common enemy and the reason why existing standard-of-care surgical interventions fail, even with systemic antibiotics," Peptilogics CEO Nick Pachuda, DPM, said in the press release. "Zaloganan quickly penetrates the biofilm locally and kills the hiding bacteria."

Among the investors in the Series B2 financing round is the AMR Action Fund, which was launched in 2020 to help companies developing promising treatments for antibiotic-resistant infections.   

"Periprosthetic joint infections are a striking example of how antimicrobial resistance is rapidly undermining modern medicine," said AMR Action Fund CEO Henry Skinner, PhD. "The financial costs, diminished quality of life, and mortality associated with such infections are frankly unacceptable, and we are pleased to support the Peptilogics team as they advance zaloganan through the clinic and toward patients in need."

In January the Combating Antibiotic-Resistant Bacteria Biopharmaceutical Accelerator (CARB-X) awarded Peptilogics $3.3 million to develop a slow-release version of zaloganan.

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  Los Angeles County Department of Public Health is investigating the year's first case of locally acquired dengue in a San Gabriel Valley resident. The patient, who became ill in late September and is recovering, reported no travel to areas endemic for the mosquito-borne infection. Last year was the first year LA reported local dengue, with 14 cases. The risk of widespread dengue virus transmission in Los Angeles County is low, officials said.

• The US National Emerging Special Pathogens Training and Education Center has announced a $37.5 million grant that will give $500,000 to as many as 75 healthcare facilities to become or maintain status as a Level 2 Special Pathogen Treatment Centers, which are designed to provide safe, high-quality care during high-consequence infectious disease outbreaks. The grant is funded by the Administration for Strategic Preparedness and Response.
• In an update today from the Africa Centre for Disease Control and Prevention (Africa CDC), officials said no new Ebola cases have been reported for 16 days, and mpox is down 65% from its peak. But Rift Valley fever (RVF) cases in people and animals are rising in Senegal and Mauritania and have killed at least 17 people, the World Organization for Animal Health (WOAH) said in a statement today. RVF is a viral hemorrhagic fever that affects mainly livestock but can also infect people. "These outbreaks appear to be linked to heavy rainfall and flooding in preceding months which have created favourable conditions for disease transmission," the WOAH statement said. "As RFV is a transboundary animal disease, regional cooperation will be essential to assess and manage the risk posed by these outbreaks."