Background Antimicrobial resistance (AMR) in Neisseria gonorrhoeae is a global concern, and gonorrhoea may become untreatable. However, AMR data from Eastern Europe are scarce beyond Russia, and in Belarus no AMR data or other characteristics of gonococci have been published in over 20 years. The aim was to describe the AMR and molecular epidemiological characteristics of gonococci circulating in 2009 and 2010 in Belarus.
Methods N gonorrhoeae isolates cultured in 2009 (n=80) and 2010 (n=78) in the two different cities Minsk (n=45) and Mogilev (n=113) were examined using Etest for nine antimicrobials and nitrocefin solution for β-lactamase production. Where available, breakpoints for susceptibility and resistance according to The European Committee on Antimicrobial Susceptibility Testing (EUCAST; http://www.eucast.org) were used. Moreover, screening for penA mosaic alleles, full-length porB gene sequencing, and N gonorrhoeae multiantigen sequence typing (NG-MAST) were performed.
Results The levels of resistance in 2009–2010 to antimicrobials evidently used in the gonorrhoea treatment in Belarus were—ceftriaxone 0%, spectinomycin 0%, azithromycin 14.4%, tetracycline 30.9%, ciprofloxacin 34.6%, and erythromycin 59.2% (only tested in 2009). The levels of resistance to other antimicrobials of international interest but not used in Belarus were—cefixime 0%, gentamicin 1.3%, and penicillin G 9.9% (only tested in 2009). Extraordinarily, no β-lactamase producing isolates were detected. The circulating N gonorrhoeae population identified was very heterogeneous and contained many divergent NG-MAST STs, of which more than half have not been previously described worldwide.
Conclusions Due to the high levels of resistance to all antimicrobials previously recommended as first-line treatment, only ceftriaxone and spectinomycin can be recommended for empirical gonorrhoea treatment in Belarus. Continuous and quality assured gonococcal AMR surveillance in Eastern Europe is crucial, in Belarus this surveillance is now initiated using WHO protocols.