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Impact of molecular ciprofloxacin resistance testing in management of gonorrhoea in a large urban clinic
  1. Emily Goldstein1,
  2. Elizabeth Moss2,
  3. Susan Bennett-Slater1,
  4. Lynne Ferguson1,
  5. Carol McInally1,
  6. Martin McHugh3,
  7. Alexandra Maxwell2,
  8. Andrew Winter2,
  9. Rory N Gunson1
  1. 1West of Scotland Specialist Virology Centre, NHS Greater Glasgow and Clyde, Glasgow, UK
  2. 2Sandyford Sexual Health Services, NHS Greater Glasgow and Clyde, Glasgow, UK
  3. 3Scottish Bacterial STI Reference Laboratory, NHS Lothian, Edinburgh, UK
  1. Correspondence to Dr Emily Goldstein, West of Scotland Specialist Virology Centre, NHS Greater Glasgow and Clyde, Glasgow G31 2ER, UK; emily.goldstein{at}ggc.scot.nhs.uk

Abstract

Objectives Antibiotic resistance in gonorrhoea is of significant public health concern with the emergence of resistance to last-line therapies such as ceftriaxone. Despite around half of Neisseria gonorrhoeae isolates tested in the UK being susceptible to ciprofloxacin, very little ciprofloxacin is used in clinical practice. Testing for the S91F mutation associated with ciprofloxacin resistance is now available in CE-marked assays and may reduce the requirement for ceftriaxone, but many patients are treated empirically, or as sexual contacts, which may limit any benefit. We describe the real-world impact of such testing on antimicrobial use and clinical outcomes in people found to have gonorrhoea in a large urban UK sexual health clinic.

Methods Molecular ciprofloxacin resistance testing (ResistancePlus GC assay (SpeeDx)) was undertaken as an additional test after initial diagnosis (m2000 Realtime CT/NG assay (Abbott Molecular)) in those not already known to have had antimicrobial treatment. Data from a 6-month period (from March to September 2022) were analysed to determine treatment choice and treatment outcome.

Results A total of 998 clinical samples tested positive for N. gonorrhoeae in 682 episodes of infection. Of the 560 (56%) samples eligible for resistance testing, 269 (48.0%) were reported as wild-type, 180 (32.1%) were predicted to be resistant, 63 (11.3%) had an indeterminate resistance profile, and in 48 (8.6%) samples, N. gonorrhoeae was not detected. Ciprofloxacin was prescribed in 172 (75%) of 228 episodes in which the wild-type strain was detected. Four (2%) of those treated with ciprofloxacin had a positive test-of-cure sample by NAAT, with no reinfection risk. All four had ciprofloxacin-susceptible infection by phenotypic antimicrobial susceptibility testing.

Conclusions In routine practice in a large UK clinic, molecular ciprofloxacin resistance testing led to a significant shift in antibiotic use, reducing use of ceftriaxone. Testing can be targeted to reduce unnecessary additional testing. Longer term impact on antimicrobial resistance requires ongoing surveillance.

  • NEISSERIA GONORRHOEAE
  • Gonorrhea
  • CIPROFLOXACIN
  • Drug Resistance, Bacterial
  • Molecular Diagnostic Techniques

Data availability statement

No data are available. Not applicable.

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Footnotes

  • Handling editor Jane S Hocking

  • X @EmilyJGoldstein, @teowinterandy

  • Contributors EG: Guarantor, conceptualisation, methodology, validation, formal analysis, investigation, writing—original draft, writing—review and editing. EM: methodology, validation, formal analysis, investigation. SB-S: Investigation. LF: Investigation. CM: Investigation. MM: Investigation. AM: Conceptualisation, methodology, writing—review and editing. AW: Conceptualisation, methodology, investigation, writing—original draft, writing—review and editing. RNG: Conceptualisation, methodology, validation, writing—review and editing.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.