To the Editor,
Antimicrobial resistance (AMR) in Neisseria gonorrhoeae (NG) has been a major health concerns globally [Citation1,Citation2]. Based on the WHO global AMR surveillance in 2017-18 [Citation1,Citation3], azithromycin resistance in NG was increasing, and decreased susceptibility or resistance to ceftriaxone and cefixime were continued. In maternity institutes in Japan, AMR in genital NG infection has been clinically determined by post-treatment nucleic acid retesting or isolation culture according to the Guideline for Gynecological Practice in Japan [Citation4]. In our previous study in Japan [Citation5], in 2017 AMR was recognized in 0.6% (3/512) of NG using azithromycin, while there was no AMR to the ceftriaxone (0/456) or cefixime (0/5).
In the current study, we requested the obstetrical facilities that are members of the Japan Association of Obstetricians and Gynecologists (JAOG) to provide information of AMR in NG in pregnant women who delivered in 2020. This study was conducted after receiving approval from the ethics committee of the JAOG.
A total of 1,459 (67.8%) of 2,146 facilities responded with possible statistical analysis information. The AMR was recognized in 0 (0/139), 2.2 (3/315) and 0% (0/20) of the pregnant women with genital NG infection using azithromycin, ceftriaxone and cefixime, respectively.
The current results suggest that the AMR of NG has changed over the last 3 years in entire Japan. The changes are not significant (p = 0.84 and 0.13 in azithromycin and ceftriaxone, respectively by X2 test), and they may be also due to the relative increase in ceftriaxone use based on the previous results. However, the fluctuation in NG genotypes has been suggested to be associated with the changes in the AMR levels in NG [Citation6–8].
In the current study, we did not perform the genomic examinations in the strains of NG with decreased susceptibility to the antibiotics; however, the recent reduced susceptibility of NG to the clinically relevant antimicrobials has been reported to be primarily attributed to alterations in several genotypes and/or mutated genes [Citation6–8]. For example, the NG genotypes were observed to fluctuate significantly within a 3-year period with some genotypes appearing or disappearing in Australia [Citation6]. The recent global emergence of strains with resistance to extended-spectrum antibiotics had raised concerns regarding a future of untreatable NG. Therefore, there may be an increased urgency to examine the underlying molecular epidemiology of the disease. In addition, the continued and strengthened AMR surveillance in NG should be prompted in each country.
Disclosure statement
No potential conflict of interest was reported by the author.
Data availability statement
All data generated or analyzed during this study are included in this article. Further inquiries can be directed to the corresponding author at [email protected] (SS).
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Funding
References
- Unemo M, Lahra MM, Escher M, et al. WHO global antimicrobial resistance surveillance for Neisseria gonorrhoeae 2017-18: a retrospective observational study. Lancet Microbe. 2021;2(11):e627–e636. doi: 10.1016/S2666-5247(21)00171-3.
- Cole MJ, Day M, Jacobsson S, et al. The european gonorrhoea response plan group; european gonorrhoea response plan group: the european response to control and manage multi- and extensively drug-resistant Neisseria gonorrhoeae. Euro Surveill. 2022;27(18):2100611.
- Unemo M, Lahra MM, Cole M, et al. World health organization global gonococcal antimicrobial surveillance program (WHO GASP): review of new data and evidence to inform international collaborative actions and research efforts. Sex Health. 2019;16(5):412–425. doi: 10.1071/SH19023.
- Kawaguchi R, Matsumoto K, Ishikawa T, et al. Guideline for gynecological practice in Japan: Japan society of obstetrics and gynecology and Japan association of obstetricians and gynecologists 2020 edition. J Obstet Gynaecol Res. 2021;47(1):5–25. doi: 10.1111/jog.14487.
- Suzuki S, Hoshi S, Sekizawa A, et al. Current status of Neisseria gonorrhoeae cervicitis in pregnant women in Japan. PLoS One. 2019;14(2):e0211595. doi: 10.1371/journal.pone.0211595.
- Lahra MM, Trembizki E, Buckley C, GRAND Study Investigators., et al. Changes in the rates of Neisseria gonorrhoeae antimicrobial resistance are primarily driven by dynamic fluctuations in common gonococcal genotypes. J Antimicrob Chemother. 2017;72(3):705–711. doi: 10.1093/jac/dkw452.
- Thomas JC, Seby S, Abrams AJ; Antimicrobial-Resistant Neisseria gonorrhoeae Working Group, et al. Evidence of recent genomic evolution in gonococcal strains with decreased susceptibility to cephalosporins or azithromycin in the United States, 2014-2016. J Infect Dis. 2020;221(5):852–853. doi: 10.1093/infdis/jiz079.
- Parmar NR, Singh R, Martin I, et al. Genomic analysis reveals Antibiotic-Susceptible clones and emerging resistance in Neisseria gonorrhoeae in Saskatchewan, Canada. Antimicrob Agents Chemother. 2020;64(9):e02514-19. doi: 10.1128/AAC.02514-19.