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GRASP: a new national sentinel surveillance initiative for monitoring gonococcal antimicrobial resistance in England and Wales
  1. Thomas C Paine1,
  2. Kevin A Fenton1,
  3. Alan Herring2,
  4. Andrew Turner2,
  5. Catherine Ison3,
  6. Iona Martin3,
  7. Angela Robinson4,
  8. George Kinghorn5
  1. 1Public Health Laboratory Service, Communicable Disease Surveillance Centre, 61 Colindale Avenue, London NW9 5EQ, UK
  2. 2Genitourinary Infections Reference Laboratory, Public Health Laboratory, Myrtle Road, Kingsdown, Bristol BS2 8EL, UK
  3. 3Department of Infectious Diseases and Microbiology, Imperial College School of Medicine, St Mary's Campus, London W2 1PG, UK
  4. 4Department of Genitourinary Medicine, Mortimer Market Centre, off Capper Street, London WC1E 6AU, UK
  5. 5Department of Genitourinary Medicine, Royal Hallamshire Hospital, Glossop Road, Sheffield S10 2JF, UK
  1. Mr Tom Paine, PHLS Communicable Disease Surveillance Centre, 61 Colindale Avenue, London NW9 5EQ, UK Tpaine{at}

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Antimicrobial resistance is a major public health problem. Two recent publications have drawn attention to the growing nature of this problem, and the potential impact on the National Health Service. A report by the House of Lords1 highlighted the alarming increase in antibiotic resistance and concluded that the problem “ought to be considered much more widely than it is at present.” This was further supported by the Standing Medical Advisory Committee's report The Path of Least Resistance,2 which underscored the need to urgently prioritise antimicrobial resistance on the national agenda and recommended the creation of a national strategy for minimising the development of antimicrobial resistance. Increasing antibiotic resistance is likely to be related to the increased use of broad spectrum agents, “over the counter” use of antibiotics, and inappropriate prescribing practices. Antibiotic resistant Neisseria gonorrhoeae may be also imported into England and Wales if infections are acquired in areas where such practices are common.

In the light of these growing concerns, there is a need to evaluate current strategies for monitoring N gonorrhoeae antimicrobial susceptibility. This article takes an evidence based approach to consider the justification for and methodology of a new national surveillance system for monitoring N gonorrhoeae antimicrobial resistance in England and Wales.

The problem

N gonorrhoeae is the second most common bacterial sexually transmitted infection (STI) in England and Wales, with over 20 000 new infections being diagnosed in genitourinary medicine (GUM) clinics in 2000.3 This figure does not include infections diagnosed outside of the GUM clinic sector or undiagnosed prevalent infections in the community. Diagnoses of uncomplicated gonorrhoea in England and Wales have continued to rise since 1994,3 with substantial annual increases as large as 20% (1995 to 1996) and 30% (1998 to 1999) being observed over recent years.4,5 The reasons …

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