Background Increasing reports of Neisseria gonorrhoeae in vitro decreased susceptibility and resistance, and treatment failures with third generation cephalosporins are of major concern as these drugs are the last remaining options for effective antimicrobial therapy in many settings.

Methods The European Gonococcal Antimicrobial Surveillance Programme (Euro-GASP), a sentinel surveillance programme funded by the European Centre for Disease Prevention and Control since 2009, monitors antimicrobial susceptibility patterns across the European Union (EU/EEA). Participating laboratories performed susceptibility testing by Etest or agar dilution breakpoint method, or sent isolates to reference laboratories in Denmark, Sweden or the United Kingdom for testing. Euro-GASP validated proficiency and result accuracy through an external quality assessment scheme.

Results In 2011, 1902 isolates from 21 countries were collected and tested. The percentage of tested isolates with decreased susceptibility to cefixime (8.0%) remained stable compared to 2010 (8.7%), but was still significantly higher than in 2009 (5.1%, p < 0.01). Isolates with decreased susceptibility to cefixime were reported from 17 countries in 2011, the same as in 2010; however three countries reported such isolates for the first time in 2011. For the first time, ten isolates with decreased susceptibility to ceftriaxone were reported from two countries. Rates of ciprofloxacin (49%) and azithromycin (5.3%) resistance remained high. Minimum inhibitory concentration of gentamicin remained low (MIC50: 4 mg/L; MIC90: 8 mg/L).

Conclusions Although the rapid increase and spread of decreased susceptibility to cefixime in 2010 has not continued, the detection of isolates with decreased susceptibility to ceftriaxone is concerning. ECDC has published a response plan which aims to strengthen surveillance of gonococcal antimicrobial susceptibility in the EU/EEA; ensure that capacity for culture and susceptibility testing is maintained; establish a system for collection and verification of data on clinical treatment failure; and to recommend public health actions at national and European level.