Background/introduction Antimicrobial resistance (AMR) in Neisseria gonorrhoeae threatens effective treatment and infection control. Treatment guidelines for gonorrhoea are revised when the prevalence of resistance to first-line therapy exceeds 5%; in the UK this last occurred in 2011, prompting a treatment guideline change from cefixime to dual therapy with ceftriaxone and azithromycin.

Aim(s)/objectives Describe emerging trends in gonococcal resistance to current and previous first-line therapies using data from the Gonococcal Resistance to Antimicrobials Surveillance Programme (GRASP).

Methods GRASP collects N. gonorrhoeae isolates from July–September annually from 27 genitourinary medicine clinics in England and Wales. The minimum inhibitory concentration (MIC) of each isolate to seven antimicrobials is determined, then linked to demographic, clinical and behavioural data. Data from 2011–2014 were considered in this analysis. For each antimicrobial, the test for trend in resistance was determined and MIC distributions were compared using the Kolmogorov–Smirnov test.

Results In 2014, there was no ceftriaxone resistance (MIC ≥ 0.125 mg/L), but the modal MIC drifted to 0.004 mg/L from 0.002 mg/L in 2011 (p < 0.001). Azithromycin resistance (MIC ≥ 1.0 mg/L) increased from 0.5% in 2011 to 1.0% in 2014 (p = 0.09). The prevalence of cefixime resistance (MIC ≥ 0.125 mg/L) declined below 5% for the first time since 2011, but the modal MIC drifted from 0.008 mg/L in 2011 to 0.015mg/L in 2014 (p < 0.001).

Discussion/conclusion Despite the decline in resistance in cefixime, the drifting MIC distribution suggests isolates are less susceptible than previous years. Ongoing monitoring of AMR with strong compliance with national treatment guidelines is essential to retain gonorrhoea as a treatable infection.