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Estimating the prevalence of gonococcal resistance to antimicrobials in England and Wales
  1. Gwenda Hughes1,
  2. Tom Nichols2,
  3. Catherine A Ison3
  1. 1HIV/STI Department, Health Protection Agency, London, UK
  2. 2Statistics, Modelling and Economics Department, Health Protection Agency, London, UK
  3. 3Sexually Transmitted Bacteria Reference Laboratory, Health Protection Agency, London, UK
  1. Correspondence to Dr Gwenda Hughes, HIV/STI Department, Health Protection Services Colindale, Health Protection Agency, 61 Colindale Avenue, London NW9 5EQ, UK;{at}


Background Gonorrhoea can rapidly develop resistance to antimicrobials and treatment options are becoming depleted. Treatment guidelines require robust estimates of the prevalence of resistance but sentinel surveillance systems may not be representative nationally.

Objective To investigate the effectiveness of the sentinel Gonococcal Resistance to Antimicrobials Surveillance System (GRASP) at estimating resistance prevalence in England and Wales.

Methods Annual cross-sectional data on reported gonorrhoea diagnoses between 2000 and 2008 were compared between GRASP (26 clinics) and national mandatory (KC60) reporting (229 clinics). Resistance prevalence estimates in GRASP were weighted according to the national distribution of relevant patient characteristics: age group, gender, sexual orientation and geographical region. Trends in actual and weighted estimates were plotted.

Results Gonorrhoea cases reported through GRASP were more likely to be from London and to be men who have sex with men (MSM) and were less likely to be women and heterosexual men than those reported through KC60. Weighting for national distributions of demographic characteristics reduced estimates of resistance prevalence, particularly ciprofloxacin in 2006 (27% to 21%). Emerging resistance to cefixime in 2008 was reduced from 1.5% to 1.0%. Weighting did not adjust resistance prevalence above or below the 5% threshold for any antimicrobial.

Conclusions Although over-representing MSM and under-representing women and heterosexual men, GRASP has provided reliable estimates of resistance prevalence in England and Wales. However, weighting for the national distribution of patient characteristics should be considered in future. As resistance usually emerges in MSM, enhanced surveillance of high-risk populations could enable development of more tailored (and therefore optimal) treatment strategies.

  • Gonorrhoea
  • surveillance
  • antimicrobial resistance
  • epidemiology (general)
  • chlamydia trachomatis
  • syphilis
  • vaginal infections
  • STD surveillance
  • laboratory diagnosis
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  • GRASP steering group

    Professor Catherine Ison, Dr Catherine Lowndes, Ms Leah de Souza-Thomas, Dr Stephanie Chisholm, Mr John Anderson, Mrs Elisabeth Maclure-Webster, Dr Alan Johnson, Professor George Kinghorn, Dr David Livermore, Dr Rohinton Mulla, Mr Tom Nichols, Dr Angela Robinson, Professor Jonathan Ross, Dr Jim Wade, Dr Christopher Bignell, Dr Kirstine Eastick and Dr John Paul.

  • GRASP collaborative Group

    EAST MIDLANDS: Dr M Minassian, Dr L Riddell, Dr V Weston, Dr C Bignell; EAST of ENGLAND: Dr M Farrington, Dr C Carne, Dr R Mulla, Dr T Balachandran. LONDON: Dr B Azadian, Dr K McLean, Dr A McOwan, Dr F Boag, John Hunter Clinic, Dr D Krahe, Dr M Nathan, Ms M Graver, Dr M Tenant-Flowers, Dr R Holliman, Dr P Hay, Dr A Jepson, Dr L Green, Dr B MacRae, Dr A Robinson, Dr S Bragman, Dr J Russell, Dr J Wade, Dr P Riley, Dr E Jungmann NORTH EAST: Prof. J Magee, Dr K N Sankar NORTH WEST: Dr T Neal, Dr P Carey, Dr A Qamruddin, Dr A Sukthankar, Dr J Anson SOUTH EAST: Dr J Paul, Dr G Dean, Dr A Stacey, Dr G Wildman, Dr M Cubbon, Dr A Tang SOUTH WEST: Dr R Spencer, Dr P Horner, Dr M Logan, Dr Z Sulaiman, Dr M Williams, Dr A Lees WALES: Dr R Howe, Dr H Birley. Dr E Kubriak, Dr R Das. WEST MIDLANDS Dr M Gill, Dr J Ross, H Jones, Dr J Gray, Dr D Dobie, Dr A Tariq YORKSHIRE & HUMBERSIDE: Dr M Denton, Dr J Clarke, Dr P Zadik, Dr G Kinghorn.

  • Funding GRASP has been funded totally (2000–2004) and partially (2005–2010) by the Department of Health (England). The views expressed in the publication are those of the authors and are not necessarily those of the Department of Health.

  • Competing interests None.

  • Ethics approval GRASP and KC60 are national public health surveillance systems run by the Health Protection Agency (HPA). The HPA has permission to handle these data under section 251 of the NHS Act 2006 (previously section 60 of the Health and Social Care Act 2001), renewed annually by the Ethics and Confidentiality Committee of the National information Governance Board. When GRASP was first established, ethics permission was obtained from local regional research committees and from the North West multicentre research ethics committee. Patients were informed of the study at the participating site through written notices.

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

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