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European surveillance of antimicrobial resistance in Neisseria gonorrhoeae
  1. Michelle J Cole1,
  2. Stephanie A Chisholm1,
  3. Steen Hoffmann2,
  4. Angelika Stary3,
  5. Catherine M Lowndes1,
  6. Catherine A Ison1,
  7. the European Surveillance of Sexually Transmitted Infections Network
  1. 1Health Protection Agency, London, UK
  2. 2Statens Serum Institut, Copenhagen, Denmark
  3. 3Ambulatorium für Pilzinfektionen, Vienna, Austria
  1. Correspondence to Michelle Cole, Sexually Transmitted Bacteria Reference Laboratory, Health Protection Agency, 61 Colindale Avenue, London NW9 5EQ, UK; michelle.cole{at}


Objective To perform a European sentinel surveillance study for antimicrobial resistance (AMR) in Neisseria gonorrhoeae as part of the European Surveillance of Sexually Transmitted Infections Programme.

Methods From 2006 to 2008 17 countries participated in the AMR surveillance programme. The susceptibility of a total of 3528 consecutive isolates was tested using the agar dilution breakpoint technique or Etests for ciprofloxacin, penicillin, tetracycline, azithromycin, spectinomycin and ceftriaxone. Nitrocefin was used to detect β-lactamase activity.

Results Rates of resistance to ciprofloxacin, the previously recommended treatment, were high across Europe (42–52%), indicating that usage is no longer appropriate. Although resistance to the currently recommended treatment, ceftriaxone, was not demonstrated, a concerning upward drift in the minimal inhibitory concentration (MIC) distribution was identified since an earlier European study in 2004. No resistance to spectinomycin was seen, whereas azithromycin resistance varied from 2% to 7% and isolates from Scotland (n=4) and Ireland (n=1) showed high-level resistance (MIC >256 mg/l). High-level resistance to tetracycline and penicillin remained relatively constant at 16% and 12%, respectively.

Conclusions AMR is an ongoing problem in Europe, with high rates of resistance to many previously recommended therapeutic agents observed in many European countries. Continual European and global surveillance of AMR in N gonorrhoeae is essential to monitor for increasing, emerging and high-level resistance to therapeutically relevant agents and to inform treatment guidelines so optimum treatments are administered.

  • Neisseria gonorrhoeae
  • Gonorrhoea
  • antimicrobial resistance
  • surveillance

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  • Members of the European Surveillance of Sexually Transmitted Infections, listed in alphabetical order by countries, are (in addition to the authors): Austria: Reinhild Strauss, FM for Health, Family and Youth; Belgium: Tania Crucitti, Institute of Tropical Medicine, André Sasse, Scientific Institute of Public Health; Cyprus: Chrystalla Hadjianastassiou, Ministry of Health; Denmark: Susan Cowan, Statens Serum Institut; Estonia: Anneli Uusküla, Tartu University Clinics, Rutta Voiko, West Tallinn Central Hospital; Finland: Eija Hiltunen-Back, National Public Health Institute; France: Véronique Goulet, Institut de Veille Sanitaire, Patrice Sednaoui, Institut Alfred Fournier; Bertille de Barbevrac, National Reference Centre of Chlamydia Infection; Germany: Peter Kohl, Dept. of Dermatology and Venerology, Vívantes Klinikum Neukölln, Osamah Hamouda, Robert-Koch Institute; Greece: Vasileia Konte, Hellenic Centre for Infectious Disease Control, Eva Tzelepi, National Reference Center for N.gonorrhoeae, Hellenic Pasteur Institute; Iceland: Guðrún Sigmundsdóttir, Centre for Infectious Disease Control, Directorate of Health, Guðrun Hauksdottir, Landspitali University Hospital; Ireland: Aidan O'Hora, Health Protection Surveillance Centre, Helen Barry, St. James Hospital; Italy: Paola Stefanelli, Barbara Suligoi, Istituto Superiore di Sanità; Latvia: Judite Pirsko, Elvira Lavrinovica, State Centre of Sexually Transmitted and Skin Diseases; Malta: Christopher Barbara, St Luke's Hospital, Jackie Maistre Melillo, Infectious Disease Prevention and Control Unit, Department of Health Promotion and Disease Prevention; Netherlands: Ineke Linde, GGD Amsterdam, Marianne van der Sande, Rijksinstituut voor Volksgezondheid en Milieu; Norway: Hilde Klovstad, Norwegian Institute of Public Health, Vegard Skogen, UNN Tromsø Universitetssykehuset; Portugal:Jacinta Azevedo, General Directorate of Health (DGS), Maria-José Borrego, Instituto Nacional de Saude Dr Ricardo Jorge; Slovak Republic; Jan Mikas, National Public Health Agency of the Slovak Republic; Slovenia: Irena Klavs, Centre for Communicable Diseases, Institute of Public Health of the Republic of Slovenia, Alenka Andlovic, Institute of Microbiology and Immunology, University of Ljubljana; Spain: Julio Vazquez, Mercedes Diez, Instituto de Salud Carlos III; Sweden: Anders Blaxhult, Inga Velicko, Swedish Institute for Infectious Disease Control, Hans Fredlund, Magnus Unemo, Swedish Reference Laboratory for Pathogenic Neisseria, Orebro University Hospital; Turkey: Peyman Altan, General Directorate of Primary Care Services, Ministry of Health; United Kingdom: Lesley Wallace, Health Protection Scotland, Hugh Young, Scottish Bacterial Sexually Transmitted Infections Reference Laboratory, Mike Catchpole, Gwenda Hughes, Emma Savage, Health Protection Agency.

  • Funding Financial support for this study was provided by the European Commission (DG SANCO), Agreement No 2004210: ESSTI European Surveillance of Sexually Transmitted Infections.

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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