Introduction Strategies to identify antimicrobial resistance (AMR) and improve antibiotic stewardship to control the spread of AMR in Neisseria gonorrhoeae (NG) are urgently needed. As part of a project to develop a point-of-care (POC) test for AMR in NG, we investigated factors that could help identify infections due to antibiotic resistant NG.
Methods We enrolled men who have sex with men (MSM) at sexual health centres in Zurich and Bern, Switzerland, from May 2015 to June 2016. All had samples taken for NG detection from urethra, rectum and pharynx. In culture positive specimens we obtained minimum inhibitory concentrations (MICs) using Etest for ciprofloxacin, ceftriaxone, cefixime and spectinomycin (EUCAST AMR breakpoints) and azithromycin (EuroGASP, >2 mg/L). We collected clinical data and patients completed an online questionnaire. We compared cases (positive NG culture and AMR) with controls (NG and no AMR) with odds ratios (OR) and 95% confidence intervals (CI). We used multivariable logistic regression in MSM with complete data for all included variables.
Results Of 230 MSM enrolled, 117 had a positive NG culture. There were 46 (39%) cases with resistant NG (ciprofloxacin, n=45, azithromycin, n=1) and 71 controls. Clinical findings did not differ between cases and controls. Cases were more likely than controls to have had sex outside Switzerland in the previous 3 months (OR 2.2, 95% CI 1.0–4.7, p=0.05), to have received oral sex (OR 5.6, 95% CI 0.7–46.8, p=0.08) and to have concurrent partnerships (OR 2.2, 95% CI 0.8–6.5, p=0.11). In multivariable analysis (39 cases, 54 controls), the association with sex abroad remained (OR 2.0, 95% CI 0.9–4.8, p=0.10), controlling for concurrency.
Conclusion In this population of MSM in Switzerland, AMR in NG might be more common in MSM who have sex abroad and who receive oral sex, possibly from asymptomatic pharyngeal NG. No clinical factors distinguished AMR from non-AMR NG infections in MSM. Strategies such as development of POC tests that detect AMR are needed to conserve last-line antibiotic treatment for NG.
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