scholarly journals Trends and determinants of antimicrobial susceptibility of Neisseria gonorrhoeae in the Netherlands, 2007 to 2015

2018 ◽  
Vol 23 (36) ◽  
Author(s):  
Sanne HI Hofstraat ◽  
Hannelore M Götz ◽  
Alje P van Dam ◽  
Marianne AB van der Sande ◽  
Birgit HB van Benthem
Keyword(s):  
The Netherlands ◽  
Neisseria Gonorrhoeae ◽  
Inhibitory Concentration ◽  
Intervention Strategies ◽  
Heterosexual Men ◽  
Transmitted Infection ◽  
Geometric Means ◽  
Adequate Treatment ◽  
Sexually Transmitted ◽  
Sex With Men

Background Neisseria gonorrhoeae antibiotic resistance surveillance is important to maintain adequate treatment. We analysed 2007–15 data from the Gonococcal Resistance to Antimicrobials Surveillance (GRAS), which currently includes 19 of 25 sexually transmitted infection (STI) centres in the Netherlands. Methods: From each patient with a gonorrhoea culture, the minimum inhibitory concentration (MIC) for several antibiotics was determined. Time trends were assessed by geometric means and linear regression of logarithmic MIC. Determinants for decreased susceptibility to ceftriaxone (MIC > 0.032 mg/L) and resistance to cefotaxime (MIC > 0.125 mg/L) and azithromycin (MIC > 0.5 mg/L) were assessed using stratified logistic regression. Results: 11,768 isolates were analysed. No ceftriaxone resistance was found. In 2015, 27 of 1,425 isolates (1.9%) were resistant to cefotaxime and 176 of 1,623 (10.9%) to azithromycin. Ceftriaxone susceptibility showed no trend (p = 0.96) during the study period, but cefotaxime MIC decreased (p < 0.0001) and azithromycin MIC increased (p < 0.0001) significantly. Concerning ceftriaxone, isolates of men who have sex with men (MSM) from 2013 (p = 0.0005) and 2014 (p = 0.0004) were significantly associated with decreased susceptibility. Significant determinants for cefotaxime resistance were having ≥ 6 partners for women (p = 0.0006). For azithromycin, isolates from MSM collected in 2012 (p = 0.0035), 2013 (p = 0.012), and 2014 (p = 0.013), or from non-Dutch (p < 0.0001) or older (≥ 35 years; p = 0.01) MSM were significantly associated with susceptibility. Resistance in heterosexual men was significantly associated with being ≥ 25 years-old (p = 0.0049) or having 3–5 partners (p = 0.01). Conclusions: No ceftriaxone resistance was found, but azithromycin MIC increased in 2007–15. Resistance determinants could help with focused intervention strategies.

scholarly journals Trends in antimicrobial susceptibility for azithromycin and ceftriaxone in Neisseria gonorrhoeae isolates in Amsterdam, the Netherlands, between 2012 and 2015

2017 ◽  
Vol 22 (1) ◽  
Author(s):  
Carolien M Wind ◽  
Maarten F Schim van der Loeff ◽  
Alje P van Dam ◽  
Henry JC de Vries ◽  
Jannie J van der Helm
Keyword(s):  
The Netherlands ◽  
Neisseria Gonorrhoeae ◽  
Treatment Strategies ◽  
Sex Partners ◽  
Hiv Status ◽  
Transmitted Infection ◽  
Sexually Transmitted ◽  
New Treatment ◽  
Sex With Men ◽  
Infection Clinic

Resistance of Neisseria gonorrhoeae to azithromycin and ceftriaxone has been increasing in the past years. This is of concern since the combination of these antimicrobials is recommended as the first-line treatment option in most guidelines. To analyse trends in antimicrobial resistance, we retrospectively selected all consultations with a positive N. gonorrhoeae culture at the sexually transmitted infection clinic, Amsterdam, the Netherlands, from January 2012 through September 2015. Minimum inhibitory concentrations (MICs) for azithromycin and ceftriaxone were analysed per year, and determinants associated with decreased susceptibility to azithromycin (MIC > 0.25 mg/L) or ceftriaxone (MIC > 0.032 mg/L) were assessed. Between 2012 and 2015 azithromycin resistance (MIC > 0.5 mg/L) was around 1.2%, the percentage of isolates with intermediate MICs (> 0.25 and ≤ 0.5 mg/L) increased from 3.7% in 2012, to 8.6% in 2015. Determinants associated with decreased azithromycin susceptibility were, for men who have sex with men (MSM), infections diagnosed in the year 2014, two infected sites, and HIV status (HIV; associated with less decreased susceptibility); for heterosexuals this was having ≥ 10 sex partners (in previous six months). Although no ceftriaxone resistance (MIC > 0.125 mg/L) was observed during the study period, the proportion of isolates with decreased ceftriaxone susceptibility increased from 3.6% in 2012, to 8.4% in 2015. Determinants associated with decreased ceftriaxone susceptibility were, for MSM, infections diagnosed in 2014, and pharyngeal infections; and for heterosexuals, infections diagnosed in 2014 or 2015, being of female sex, and having ≥ 10 sex partners. Continued decrease of azithromycin and ceftriaxone susceptibility will threaten future treatment of gonorrhoea. Therefore, new treatment strategies are warranted.

scholarly journals Extragenital Gonorrhoea in Men Who Have Sex with Men: A Retrospective Study in a STI Clinic in Lisbon, Portugal

2018 ◽  
Vol 31 (5) ◽  
pp. 247 ◽  
Author(s):  
Margarida Moura Valejo Coelho ◽  
Eugénia Matos-Pires ◽  
Vasco Serrão ◽  
Ana Rodrigues ◽  
Cândida Fernandes
Keyword(s):  
Human Immunodeficiency Virus ◽  
Retrospective Study ◽  
Neisseria Gonorrhoeae ◽  
Sexually Transmitted Infection ◽  
Transmitted Infection ◽  
Sexually Transmitted ◽  
Sexually Transmitted Infection Clinic ◽  
Immunodeficiency Virus ◽  
Sex With Men ◽  
Infection Clinic

Introduction: Recent studies worldwide reveal a significant prevalence of extragenital infections by Neisseria gonorrhoeae among men who have sex with men. We aimed to analyse the frequency and characteristics of extragenital gonococcal infections diagnosed in men who have sex with men in a walk-in Sexually Transmitted Infection clinic in Lisbon, Portugal.Material and Methods: We conducted a cross-sectional, retrospective study of the anorectal and/or oropharyngeal Neisseria gonorrhoeae infections in men who have sex with men, diagnosed in our Sexually Transmitted Infection clinic between January 2014 and December 2016.Results: We found extragenital infection in 87 cases of gonorrhoea identified in men who have sex with men in this period, including: 49 cases of anorectal disease, 9 of oropharyngeal disease, 13 cases of infection at both extragenital sites, and 16 of simultaneous extragenital and urogenital gonorrhoea. Patients’ ages ranged from 17 to 64 years (median: 28 years). Forty-seven (54%) of the patients did not present with any extragenital symptoms. Thirty (35%) were human immunodeficiency virus-1-positive.Discussion: Since most extragenital Neisseria gonorrhoeae infections are asymptomatic, they may be missed and go untreated unless actively investigated. Current international guidelines recommend the screening of gonorrhoea at extragenital sites in men who have sex with men because anorectal and oropharyngeal infections constitute a potential disease reservoir, and may facilitate transmission and/or acquisition of human immunodeficiency virus infection.Conclusion: Our results highlight the relevance of testing men who have sex with men for Neisseria gonorrhoeae at extragenital sites, regardless of the existence of local complaints. The implementation of adequate screening programmes in Portugal should be considered. We also reinforce the need to raise awareness in the population regarding the adoption of prophylactic measures against transmission of sexually transmitted infections during anal and/or oral sexual exposure.

scholarly journals Increasing sexually transmitted infection rates in young men having sex with men in the Netherlands, 2006–2012

2014 ◽  
Vol 11 (1) ◽  
pp. 12 ◽  
Author(s):  
Femke DH Koedijk ◽  
Birgit HB van Benthem ◽  
Eliane MDC Vrolings ◽  
Wim Zuilhof ◽  
Marianne AB van der Sande
Keyword(s):  
The Netherlands ◽  
Sexually Transmitted Infection ◽  
Young Men ◽  
Infection Rates ◽  
Transmitted Infection ◽  
Sexually Transmitted ◽  
Sex With Men

scholarly journals Multidrug-resistant Neisseria gonorrhoeae with reduced cefotaxime susceptibility is increasingly common in men who have sex with men, Amsterdam, the Netherlands

2009 ◽  
Vol 14 (37) ◽  
Author(s):  
H JC de Vries ◽  
J J van der Helm ◽  
M F Schim van der Loeff ◽  
A P van Dam
Keyword(s):  
The Netherlands ◽  
Neisseria Gonorrhoeae ◽  
Treatment Options ◽  
Multidrug Resistant ◽  
Considerable Proportion ◽  
Third Generation ◽  
Sexually Transmitted ◽  
Sex With Men ◽  
Third Generation Cephalosporins ◽  
Multiple Antibiotics

Antimicrobial resistance is an increasing problem in Neisseria gonorrhoeae (NG) treatment. Presently, third-generation parenteral cephalosporins, like ceftriaxone and cefotaxime, are the first option. Resistance to oral, but not to parenteral, third-generation cephalosporins has been reported previously. We analysed the microbial susceptibility (as minimum inhibitory concentration - MIC) of NG cultures obtained from high-risk visitors of the largest Dutch outpatient clinic for sexually transmitted infections (STI) in Amsterdam, the Netherlands. Among 1,596 visitors, we identified 102 patients with at least one NG isolate with reduced susceptibility to cefotaxime (0.125 μg/ml < MIC ≤ 0.5 μg/ml). The percentage of NG isolates with reduced susceptibility to cefotaxime rose from 4.8% in 2006 to 12.1% in 2008 (chi2 17.5, p<0.001). With multivariate logistic regression, being a man who has sex with men (MSM) was significantly associated with reduced susceptibility to cefotaxime (p<0.001). Compared to susceptible NG isolates, those with decreased susceptiblity to cefotaxime were more often resistant also to penicillin (16.5% vs. 43.3%), tetracycline (21.5% vs. 68.9%) and ciprofloxacin (44.4% vs. 90.0%, all p<0.001). The increased prevalence of NG strains with reduced susceptibility to cefotaxime among MSM may herald resistance to third-generation parenteral cephalosporins. A considerable proportion of these strains show resistance to multiple antibiotics which could limit future NG treatment options.

Clinical significance of questionnaire-elicited or clinically reported anorectal symptoms for rectal Neisseria gonorrhoeae and Chlamydia trachomatis amongst men who have sex with men

Sexual Health ◽  
2008 ◽  
Vol 5 (1) ◽  
pp. 77 ◽  
Author(s):  
Nichole A. Lister ◽  
Nadia J. Chaves ◽  
Chee W. Pang ◽  
Anthony Smith ◽  
Christopher K. Fairley
Keyword(s):  
Chlamydia Trachomatis ◽  
Neisseria Gonorrhoeae ◽  
Clinical Significance ◽  
Recruitment Rate ◽  
National Guidelines ◽  
Transmitted Infection ◽  
Clinical Indicators ◽  
Sexually Transmitted ◽  
Clinical Consultation ◽  
Sex With Men

Background: Although Neisseria gonorrhoeae (Ng) and Chlamydia trachomatis (Ct) are common infections in men who have sex with men, it is unclear from previous studies whether anorectal symptoms are reliable clinical indicators of infection. Aim: The objective of the study was to investigate the clinical significance of questionnaire-elicited or clinically reported anal symptoms for rectal Ng and Ct. Methods: During 2002 to 2003, men who have sex with men (MSM) screened or tested for Ng or Ct according to the national guidelines were invited to participate in a questionnaire. Results: During the study period, 366 MSM were enrolled into the study (88% recruitment rate), of whom 20 (5%) and 25 (7%) were diagnosed with rectal Ng or Ct, respectively. Overall, ‘any’ anorectal symptoms on a questionnaire were reported equally by those with and without rectal Ng (75 v. 74%, P = 0.69), but heavy anal discharge (P < 0.01) and anal pain (P = 0.04) were more common in those with rectal Ng. Symptoms on the questionnaire were not different among those with and without Ct. Any anal symptoms were reported substantially more often via questionnaire than in a clinical consultation (75 v. 16%, P < 0.01) and symptoms reported in a clinical consultation were not associated with Ng or Ct detection. Conclusion: The weak or absent association between symptoms and the presence of Ct or Ng highlights the importance of annual sexually transmitted infection screening in MSM regardless of symptoms.

scholarly journals Characteristics and Dissemination of Mosaic Penicillin-Binding Protein 2-Harboring Multidrug-Resistant Neisseria gonorrhoeae Isolates with Reduced Cephalosporin Susceptibility in Northern Taiwan

2010 ◽  
Vol 54 (11) ◽  
pp. 4893-4895 ◽  
Author(s):  
Chung-Ter Huang ◽  
Muh-Yong Yen ◽  
Wing-Wai Wong ◽  
Lan-Hui Li ◽  
Kun-Yen Lin ◽  
...  
Keyword(s):  
Neisseria Gonorrhoeae ◽  
Multidrug Resistant ◽  
Bisexual Men ◽  
Penicillin Binding Protein ◽  
Transmitted Infection ◽  
Sexually Transmitted ◽  
Sex With Men ◽  
Sequence Types ◽  
Northern Taiwan ◽  
Major Sequence

ABSTRACT Among 254 Neisseria gonorrhoeae isolates from a sexually transmitted infection (STI) clinic in northern Taiwan, 69 isolates were found to contain the mosaic penA (MA) gene and were associated with elevated cefixime and ceftriaxone MICs. Most of these MA gene-harboring isolates were also resistant to penicillin (71.4%) and ciprofloxacin (100%) and were from men who have sex with men (MSM) or from bisexual men (81.2%). Three major sequence types (ST835, ST2180, and ST2253) constituted 55.7% of these isolates. The major sequence types harboring the mosaic penA gene may represent major sexual networks responsible for the emergence/introduction and the spread of the multidrug-resistant clones in Taiwan.

scholarly journals Men and Women Have Similar Neisseria gonorrhoeae Bacterial Loads: a Comparison of Three Anatomical Sites

2020 ◽  
Vol 58 (11) ◽  
Author(s):  
Brian M. J. W. van der Veer ◽  
Christian J. P. A. Hoebe ◽  
Nicole H. T. M. Dukers-Muijrers ◽  
Lieke B. van Alphen ◽  
Petra F. G. Wolffs
Keyword(s):  
Neisseria Gonorrhoeae ◽  
Bacterial Load ◽  
Large Population ◽  
Transmitted Infection ◽  
Men And Women ◽  
Content Type ◽  
Transmission Potential ◽  
Sexually Transmitted ◽  
Standard Curve ◽  
Sex With Men

ABSTRACT Neisseria gonorrhoeae is a common bacterial sexually transmitted infection (STI). Currently, there are limited data on the bacterial load in both men and women and on both genital and extragenital sites. Therefore, we quantified N. gonorrhoeae bacterial loads in a large population of women, heterosexual men, and men who have sex with men (MSM) at three different anatomical sites. N. gonorrhoeae-positive samples (n = 1265) of STI clinic consultations (n = 944) were tested for N. gonorrhoeae with the Roche Cobas 4800 system, and quantification cycle (Cq) values were used as an inversely proportional measure for N. gonorrhoeae bacterial load after interpolation from a standard curve. Bacterial loads were compared between sample materials and sexes using t tests. The following mean N. gonorrhoeae loads were observed: urine, 4.5 ± 1.0 log10 CFU/ml; vaginal swabs, 4.3 ± 1.1 log10 CFU/ml; anorectal swabs (women), 4.0 ± 1.2 log10 CFU/ml; anorectal swabs (men), 4.5 ± 1.3 log10 CFU/ml; oropharyngeal swabs (women), 2.8 ± 0.9 log10 CFU/ml; and oropharyngeal swabs (men), 3.2 ± 1.0 log10 CFU/ml. Oropharyngeal swabs had a significantly lower N. gonorrhoeae load (P < 0.001) than genital and anorectal samples. Loads did not differ between men and women. This is the first study that determined N. gonorrhoeae load in both women and men at three anatomical sites. The substantial N. gonorrhoeae load at all sample sites suggest that all sites may have transmission potential. However, the oropharyngeal site presents the lowest bacterial load. Men and women have a similar N. gonorrhoeae loads on separate anatomical sites, arguing for similar transmission potential and similar clinical relevance.

scholarly journals Antibiotic Use before Chlamydia and Gonorrhea Genital and Extragenital Screening in the Sexually Transmitted Infection Clinical Setting

2014 ◽  
Vol 59 (1) ◽  
pp. 121-128 ◽  
Author(s):  
Nicole H. T. M. Dukers-Muijrers ◽  
Genevieve A. F. S. van Liere ◽  
Petra F. G. Wolffs ◽  
Casper Den Heijer ◽  
Marita I. L. S. Werner ◽  
...  
Keyword(s):  
Sexually Transmitted Infection ◽  
Clinical Setting ◽  
Antibiotic Use ◽  
Antibiotic Consumption ◽  
Heterosexual Men ◽  
Transmitted Infection ◽  
Content Type ◽  
Sexually Transmitted ◽  
Sex With Men ◽  
Test Result

ABSTRACTBackground antibiotic use (i.e., administration of antibiotics not directly related toChlamydia trachomatisorNeisseria gonorrhoeaeinfections) has been associated with a lower prevalence of genitalC. trachomatisinfection in a clinical setting. Associations with specific antibiotic types or withN. gonorrhoeaeare lacking. Here, we assessed the prevalence of antibiotic use, the different classes and agents used, and their association with a subsequent sexually transmitted infection (STI) clinicC. trachomatisandN. gonorrhoeaetest result. At our STI clinic, we systematically registered whether antibiotics were used in the past month (in 29% of the cases, the specific antibiotic agent was named). Patients were screened for urogenitalC. trachomatisandN. gonorrhoeae; a third of them were also screened for anorectal and oropharyngealC. trachomatisandN. gonorrhoeae. The proportion of antibiotics used and their association withC. trachomatisandN. gonorrhoeaeprevalence were assessed for heterosexual men, men who have sex with men (MSM), and women. During 14,775 clinic consultations, antibiotic use was reported by 12.2% (95% confidence interval [CI], 11.7% to 12.7%), i.e., 14.8% of women, 8.6% of heterosexual men, and 11.6% of MSM. The most reported antibiotics were penicillins, tetracyclines, and macrolides, respectively. The prevalence was 11.0% (95% CI, 10.3% to 11.3%) forC. trachomatisand 1.9% (95% CI, 1.7% to 2.1%) forN. gonorrhoeae. Only tetracycline use was associated with a lowerC. trachomatisprevalence (3%). Overall antibiotic use was associated with lower anorectalC. trachomatisprevalence in MSM only (odds ratio, 0.4; 95% CI, 0.2 to 0.8). STI clinic visitors commonly report recent antibiotic use. Even in a country with low antibiotic consumption, tetracycline use impactedC. trachomatisprevalence, while there was a notable absence of association with azithromycin.

scholarly journals What Is the Optimal Testing Strategy for Oropharyngeal Neisseria gonorrhoeae in Men Who Have Sex With Men? Comparing Selective Testing Versus Routine Universal Testing From Dutch Sexually Transmitted Infection Clinic Data (2008–2017)

2019 ◽  
Vol 71 (4) ◽  
pp. 944-951 ◽  
Author(s):  
Geneviève A F S van Liere ◽  
Nicole H T M Dukers-Muijrers ◽  
Sophie Kuizenga-Wessel ◽  
Hannelore M Götz ◽  
Christian J P A Hoebe
Keyword(s):  
Risk Factors ◽  
Neisseria Gonorrhoeae ◽  
Sexually Transmitted Infection ◽  
Transmitted Infection ◽  
Sexually Transmitted ◽  
Universal Testing ◽  
Testing Data ◽  
Independent Risk Factors ◽  
Sex With Men ◽  
Infection Clinic

Abstract Background Most oropharyngeal Neisseria gonorrhoeae infections are asymptomatic, and many infections remain undetected, creating a reservoir for ongoing transmission and potential drug resistance. It is unclear what the optimal testing policy is in men who have sex with men (MSM), as routine universal testing data are lacking. Methods Surveillance data from all Dutch sexually transmitted infection (STI) clinics between 2008 and 2017 were used (N = 271 242 consultations). Oropharyngeal testing policy was defined as routine universal testing when ≥85% of consultations included oropharyngeal testing or as selective testing (&lt;85% tested). Independent risk factors for oropharyngeal N. gonorrhoeae were assessed among MSM routinely universally screened using backward multivariable logistic regression analyses. Results Routine universal testing was performed in 90% (238 619/265 127) of consultations. Prevalence was higher using routine universal testing (5.5%; 95% CI, 5.4–5.6; 12 769/233 476) than with selective testing (4.7%; 95% CI, 4.4–5.0; 799/17 079; P &lt; .001). Proportions of oropharyngeal-only infections were 55% and 47%, respectively. Independent risk factors were age &lt;31 years (OR, 2.1; 95% CI, 1.9–2.3), age 31–43 years (OR, 1.7; 95% CI, 1.6–1.9, compared with &gt;43 years), being notified for any STI (OR, 2.0; 95% CI, 1.9–2.1), concurrent urogenital N. gonorrhoeae (OR, 2.4; 95% CI, 2.1–2.7), and concurrent anorectal N. gonorrhoeae (OR, 11.4; 95% CI, 10.6–12.3). When using any of the risk factors age, notified, or oral sex as testing indicators, 98.4% (81 022/82 332) of MSM would be tested, finding 99.5% (4814/4838) of infections. Conclusions Routine universal testing detected more oropharyngeal N. gonorrhoeae infections than selective testing, of which more than half would be oropharyngeal only. Using independent risk factors as testing indicator is not specific. Therefore, routine universal oropharyngeal testing in MSM is feasible and warranted, as currently advised in most guidelines.

The value of testing multiple anatomic sites for gonorrhoea and chlamydia in sexually transmitted infection centres in the Netherlands, 2006–2010

2012 ◽  
Vol 23 (9) ◽  
pp. 626-631 ◽  
Author(s):  
F D H Koedijk ◽  
J E A M van Bergen ◽  
N H T M Dukers-Muijrers ◽  
A P van Leeuwen ◽  
C J P A Hoebe ◽  
...  
Keyword(s):  
The Netherlands ◽  
Sexually Transmitted Infection ◽  
Current Practice ◽  
Chlamydia Screening ◽  
National Surveillance ◽  
Anatomic Site ◽  
Transmitted Infection ◽  
Sexually Transmitted ◽  
Testing Practices ◽  
Sex With Men

National surveillance data from 2006 to 2010 of the Dutch sexually transmitted infection (STI) centres were used to analyse current practices on testing extragenital sites for chlamydia and gonorrhoea in men who have sex with men (MSM) and women. In MSM, 76.0% and 88.9% were tested at least at one extragenital site (pharyngeal and/or anorectal) for chlamydia and gonorrhoea, respectively; for women this was 20.5% and 30.2%. Testing more than one anatomic site differed by STI centre, ranging from 2% to 100%. In MSM tested at multiple sites, 63.0% and 66.5% of chlamydia and gonorrhoea diagnoses, respectively, would have been missed if screened at the urogenital site only, mainly anorectal infections. For women tested at multiple sites, the proportions of missed chlamydia and gonorrhoea diagnoses would have been 12.9% and 30.0%, respectively. Testing extragenital sites appears warranted, due to the numerous infections that would have been missed. Adding anorectal screening to urogenital screening for all MSM visiting an STI centre should be recommended. Since actual testing practices differ by centre, there is a need for clearer guidelines. Routine gonorrhoea and chlamydia screening at multiple sites in STI centres should be investigated further as this might be a more effective approach to reduce transmission than current practice.

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