Background In the Netherlands, the gonorrhoea resistance to antimicrobials surveillance (GRAS) programme is carried out at STI clinics, which provide care for high-risk populations. However, half of gonorrhoea infections are diagnosed in general practice (GP). We performed a pilot study to explore expanding GRAS to the GP population using laboratory-based surveillance. Additionally, antimicrobial resistance patterns of GP and STI clinic patients were compared.

Methods Three laboratories from different regions were included, which all perform gonorrhoea diagnostics for GPs and STI clinics and used eSwab for patient sampling. Additional culturing for all GP patients with gonorrhoea took place from February to July 2018. After positive PCR-NAAT test, residual eSwab material was used for culture. In positive cultures, susceptibility testing was performed for azithromycin, ciprofloxacin, cefotaxime and ceftriaxone using Etest.

Results During the study period, 484 samples were put in culture. 16.5% of cultures were positive (n=80). Antimicrobial resistance levels were low, with 2.6% resistance to azithromycin, 21.5% to ciprofloxacin and 0.0% to cefotaxime and ceftriaxone. Resistance levels in STI clinic GRAS data (first half of 2018) were 19.2% for azithromycin, 31.5% for ciprofloxacin, 1.9% for cefotaxime and 0.0% for ceftriaxone.

Conclusion Culture positivity rates for GP patients were low, probably due to long transportation times and awaiting PCR test results. Positivity rates might be improved by making changes in sampling and/or transportation methods, but that would require involvement of GPs and patients instead of keeping the surveillance lab-based. Resistance levels appeared to be much lower at the GP than at STI clinics, indicating that resistance might emerge first in more high-risk populations that visit the STI clinics. It is important to consider all potentially relevant patient populations when establishing a surveillance programme. Based on the findings from this study the current GRAS programme will not be extended to the GP population.

Disclosure No significant relationships.