Introduction The European Centre for Disease Prevention and Control is responsible for the enhanced surveillance of sexually transmitted infections and co-ordinates the European gonococcal antimicrobial surveillance programme (Euro-GASP) in the European Union and the European Economic Area. Linked patient and antimicrobial susceptibility data from Euro-GASP allows those at risk of acquiring antimicrobial resistant Neisseria gonorrhoeae to be identified.

Methods Seventeen countries in 2009 and 21 countries in 2010 and 2011 submitted gonococcal isolates to Euro-GASP, which were tested by Etest or agar dilution for cefixime, ceftriaxone, ciprofloxacin, azithromycin, spectinomycin and gentamicin. Additional patient data linked to the gonococcal isolates susceptibility profiles was collected. All three years antimicrobial susceptibility data and linked patient data were combined. Patient variables associated with resistance were established using a univariate and multivariable analyses of odds ratios. Geometric means for ceftriaxone and cefixime MICs were calculated.

Results A total of 5034 gonococcal isolates were tested in Euro-GASP from 2009 to 2011. In the multivariable analysis heterosexuals (males only for ciprofloxacin), older patients and those without a concurrent chlamydia infection remained significantly more likely to be infected with isolates displaying cefixime decreased susceptibility and ciprofloxacin resistance. The geometric mean of cefixime and ceftriaxone MICs decreased from 2009 to 2011, most significantly for MSM; MSM had lower geometric means than heterosexuals in 2011. A bimodal MIC distribution of a ‘more susceptible’ and ‘less susceptible’ gonococcal population appears to be emerging alongside this geometric mean decrease.

Conclusion This Euro-GASP data suggests that the burden of gonococcal antimicrobial resistance is more prevalent among heterosexuals and decreasing in MSM. This study shows the importance of collecting and analysing patient data along with susceptibility data, however improved data numbers and representativeness is required before any focused treatments or public health intervention strategies are initiated.