Background The Korea Centers for Disease Control and Prevention established the new nationwide surveillance system and conducted the first nationwide surveillance of antimicrobial resistance for three major sexually transmitted pathogens; Neisseria gonorrhoeae, Chlamydia trachomatis, and Mycoplasma genitalium.

Methods The urethral discharge was collected from male patients with urethritis at 20 primary urologic clinics from January 2017 to December 2018. The cervical swab was collected from female patients with cervicitis at 8 primary gynecological clinics from January to December 2018. All specimens were sent to the 4 regional or the central laboratories.

Results A total of 224 N . gonorrhoeae isolates were collected. Of these, 90.6% were resistant to tetracycline, 95.3% to ciprofloxacin, and 58.0% to penicillin. None of the strains was resistant to ceftriaxone and spectinomycin. The minimum inhibitory concentration (MIC) range of ceftriaxone was ≤0.008–0.25 μg/mL and the MIC50 and MIC90 were 0.06 μg/mL and 0.12 μg/mL. Twenty-two strains were resistant to cefixime (MIC 0.5 μg/mL). Most of the penA genotypes were type X. In particular, the proportion of mosaicism in DNA specimens has been steadily increasing, and the spread of penA-34.001 was confirmed in 2018. Reduced azithromycin susceptibility (defined MIC ≥1.0 μg/mL) increased from 0% in 2017 to 13% in 2018. The MIC range, MIC50 and MIC90 of gentamicin were 2–16 μg/mL, 4 μg/mL and 8 μg/mL, respectively.

Conclusion In South Korea, the antimicrobial resistance of N. gonorrhoeae is very severe and most isolates are multi-drug resistant to penicillin G, tetracycline, and fluoroquinolones. PenA-10.001 and penA-34.001, which are mainly isolated in South Korea, are thought to be the pre-stage of ceftriaxone-resistant germs in Japan and Europe, and the possibility of highly resistant germs is highly increased in South Korea. Enhanced antimicrobial resistance surveillance is necessary to prevent transmission of these strains.

Disclosure No significant relationships.