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P681 Importation of ciprofloxacin resistant neisseria gonorrhoeae into the UK: a public health challenge


Background Current UK guidelines for managing Neisseria gonorrhoeae (NG) infection include ciprofloxacin use if antimicrobial susceptibility is indicated, but this option would be less useful if ciprofloxacin resistant NG (CpR-NG) rates increased, for example to levels reported in some parts of Asia. CpR-NG rates in the Americas are lower than in the UK. We investigated whether having recent condomless sex in “high” CpR-NG (HCpR-NG) regions (sex abroad, but not in the Americas) was associated with being infected with CpR-NG.

Methods We conducted two cross-sectional surveys of UK Sexual Health Clinics (March 2015-March 2016; May 2017-June 2018). Patients aged ≥16 years with symptoms of an STI provided samples: vulvovaginal swab (females); first void urine (men-who-have-sex-with-women (MSW) and men-who-have-sex-with-men (MSM)); pharyngeal and rectal swabs (MSM). Data were collected on travel-associated sexual behaviour, including condomless sex abroad (CSA) in the past three months with a new partner. Routine clinic NG results were obtained. Resistance-associated mutations in gyrA (fluoroquinolones) for NG were identified using Sanger sequencing. Patients reporting CSA in HCpR-NG regions were compared to no sex abroad using Pearson’s chi-squared test and multivariable logistic regression models.

Results Overall, 71/1055 (6.7%) reported CSA in HCpR-NG regions. Of these, 12/71 (16.9%) compared to 85/984 (8.6%) not reporting CSA had NG (p=0.02). Among-NG positive patients, fluoroquinolone resistant mutations were found in 9/12 (75.0%) patients reporting CSA in HCpR-NG regions, compared to 35/85 (41.2%) who did not report CSA (p=0.03). After adjustment for other risk factors, the association between fluoroquinolone resistant NG and CSA in HCpR-NG regions remained significant (aOR:2.33[95%CI:1.03–5.24]).

Conclusion Having recent condomless sex with a new partner in regions of high ciprofloxacin resistance was associated with being NG-positive in the UK and having ciprofloxacin resistant NG. Importation of resistance may undermine attempts to recycle older antibiotics in the management of NG infection.

Disclosure No significant relationships.

  • Neisseria gonorrhoeae
  • antimicrobial resistance
  • travel

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