Molecular diagnostics for gonorrhoea: implications for antimicrobial resistance and the threat of untreatable gonorrhoea

Nicola Low, Magnus Unemo, Jørgen Skov Jensen, Judith Breuer, Judith M Stephenson, Nicola Low, Magnus Unemo, Jørgen Skov Jensen, Judith Breuer, Judith M Stephenson

Abstract

This Essay from Nicola Low and colleagues discusses the importance of the nucleic acid amplification tests for rapid detection of N. gonorrhoeae and its resistance determinants, as well as the importance of ensuring their rational use, as priorities for controlling both gonorrhoea and antimicrobial resistance.

Please see later in the article for the Editors' Summary

Conflict of interest statement

NL is a member of the Editorial Board of PLOS Medicine. The other authors have declared that no competing interests exist.

Figures

Figure 1. Trend in number of cases…
Figure 1. Trend in number of cases of gonorrhoea diagnosed, NAAT testing for gonorrhoea, and selected antimicrobial resistance in genitourinary medicine clinics in England and Wales.
Cases of gonorrhoea are from Public Health England; percentages of tests done using NAATs are from UK audits of asymptomatic patients in genitourinary medicine clinics (http://www.bashh.org/BASHH/BASHH_Groups/National_Audit_Group/BASHH/BASHH_Groups/National_Audit_Group.aspx?hkey=c17918b8-5c72-40bd-981f-632f89e45708). Percentage of isolates resistant to ciprofloxacin and cefixime are from reference and the 2012 report of the UK Gonococcal Resistance to Antimicrobials Surveillance Programme (GRASP, http://www.hpa.org.uk/Topics/InfectiousDiseases/InfectionsAZ/Gonorrhoea/AntimicrobialResistance/), with values obtained using PlotDigitizer software (http://plotdigitizer.sourceforge.net/).

References

    1. Davies SC, Fowler T, Watson J, Livermore DM, Walker D (2013) Annual Report of the Chief Medical Officer: infection and the rise of antimicrobial resistance. Lancet 381: 1606–1609.
    1. World Health Organization (2012) Global action plan to control the spread and impact of antimicrobial resistance in Neisseria gonorrhoeae. Geneva: World Health Organization.
    1. Ison CA, Town K, Obi C, Chisholm S, Hughes G, et al. (2013) Decreased susceptibility to cephalosporins among gonococci: data from the Gonococcal Resistance to Antimicrobials Surveillance Programme (GRASP) in England and Wales, 2007–2011. Lancet Infect Dis 13: 762–768.
    1. Ohnishi M, Golparian D, Shimuta K, Saika T, Hoshina S, et al. (2011) Is Neisseria gonorrhoeae initiating a future era of untreatable gonorrhea?: detailed characterization of the first strain with high-level resistance to ceftriaxone. Antimicrob Agents Chemother 55: 3538–3545.
    1. Tapsall JW, Ndowa F, Lewis DA, Unemo M (2009) Meeting the public health challenge of multidrug- and extensively drug-resistant Neisseria gonorrhoeae . Expert Rev Anti Infect Ther 7: 821–834.
    1. Zappa F (1979) Why does it hurt when I pee? Joe's Garage: Zappa Records.
    1. Unemo M, Nicholas RA (2012) Emergence of multidrug-resistant, extensively drug-resistant and untreatable gonorrhea. Future Microbiol 7: 1401–1422.
    1. Allen VG, Farrell DJ, Rebbapragada A, Tan J, Tijet N, et al. (2011) Molecular analysis of antimicrobial resistance mechanisms in Neisseria gonorrhoeae isolates from Ontario, Canada. Antimicrob Agents Chemother 55: 703–712.
    1. Lewis DA, Sriruttan C, Muller EE, Golparian D, Gumede L, et al. (2013) Phenotypic and genetic characterization of the first two cases of extended-spectrum-cephalosporin-resistant Neisseria gonorrhoeae infection in South Africa and association with cefixime treatment failure. J Antimicrob Chemother 68: 1267–1270.
    1. Lawn SD, Brooks SV, Kranzer K, Nicol MP, Whitelaw A, et al. (2011) Screening for HIV-associated tuberculosis and rifampicin resistance before antiretroviral therapy using the Xpert MTB/RIF assay: a prospective study. PLoS Med 8: e1001067.
    1. Diekema DJ, Pfaller MA (2013) Rapid Detection of Antibiotic Resistant Organism Carriage for Infection Prevention. Clin Infect Dis 56: 1614–1620.
    1. Pai NP, Vadnais C, Denkinger C, Engel N, Pai M (2012) Point-of-care testing for infectious diseases: diversity, complexity, and barriers in low- and middle-income countries. PLoS Med 9: e1001306.
    1. Menzies NA, Cohen T, Lin HH, Murray M, Salomon JA (2012) Population health impact and cost-effectiveness of tuberculosis diagnosis with Xpert MTB/RIF: a dynamic simulation and economic evaluation. PLoS Med 9: e1001347.
    1. Katz AR, Effler PV, Ohye RG, Brouillet B, Lee MV, et al. (2004) False-positive gonorrhea test results with a nucleic acid amplification test: the impact of low prevalence on positive predictive value. Clin Infect Dis 38: 814–819.
    1. Klausner JD (2004) The NAAT is out of the bag. Clin Infect Dis 38: 820–821.
    1. Herrmann B, Torner A, Low N, Klint M, Nilsson A, et al. (2008) A new genetic variant of Chlamydia trachomatis in Sweden: National study of impact on detection rates. Emerg Infect Dis 14: 1462–1465.
    1. Zenilman JM, Miller WC, Gaydos C, Rogers SM, Turner CF (2003) LCR testing for gonorrhoea and chlamydia in population surveys and other screenings of low prevalence populations: coping with decreased positive predictive value. Sex Transm Infect 79: 94–97.
    1. World Health Organization (2003) Guidelines for the Management of Sexually Transmitted Infections; Revised version 2003. Geneva: World Health Organization.
    1. Pitts MK, Smith AMA, Mischewski A, Fairley C (2005) Men, bodily change and urethritis: a qualitative study. Sex Health 2: 25–28.
    1. Bignell C, Unemo M (2013) 2012 European Guideline on the diagnosis and treatment of gonorrhoea. Int J STD AIDS 24: 85–92.
    1. Clark JL, Lescano AG, Konda KA, Leon SR, Jones FR, et al. (2009) Syndromic management and STI control in urban Peru. PLoS One 4: e7201.
    1. Whiley DM, Tapsall JW, Sloots TP (2006) Nucleic acid amplification testing for Neisseria gonorrhoeae: an ongoing challenge. J Mol Diagn 8: 3–15.
    1. Dicker LW, Mosure DJ, Steece R, Stone KM (2007) Laboratory tests used in US public health laboratories for sexually transmitted diseases, 2004. Sex Transm Dis 34: 41–46.
    1. Ison CA (2012) Antimicrobial resistance in sexually transmitted infections in the developed world: implications for rational treatment. Curr Opin Infect Dis 25: 73–78.
    1. Sadiq ST, Dave J, Butcher PD (2010) Point-of-care antibiotic susceptibility testing for gonorrhoea: improving therapeutic options and sparing the use of cephalosporins. Sex Transm Infect 86: 445–446.
    1. Ohnishi M, Saika T, Hoshina S, Iwasaku K, Nakayama S, et al. (2011) Ceftriaxone-resistant Neisseria gonorrhoeae, Japan. Emerg Infect Dis 17: 148–149.
    1. Young H, Anderson J, Moyes A, McMillan A (1997) Non-cultural detection of rectal and pharyngeal gonorrhoea by the Gen-Probe PACE 2 assay. Genitourin Med 73: 59–62.
    1. Price IH, Menon-Johansson A, Daniels D (2006) National Audit Group of the British Association for Sexual Health and HIV (2006) A national audit of gonorrhoea management. Int J STD AIDS 17: 133–134.
    1. Golden MR, Hughes JP, Cles LE, Crouse K, Gudgel K, et al. (2004) Positive predictive value of Gen-Probe APTIMA Combo 2 testing for Neisseria gonorrhoeae in a population of women with low prevalence of N. gonorrhoeae infection. Clin Infect Dis 39: 1387–1390.
    1. Furuya R, Onoye Y, Kanayama A, Saika T, Iyoda T, et al. (2007) Antimicrobial resistance in clinical isolates of Neisseria subflava from the oral cavities of a Japanese population. J Infect Chemother 13: 302–304.
    1. Centers for Disease Control and Prevention (2012) Update to CDC's Sexually Transmitted Diseases Treatment Guidelines, 2010: Oral Cephalosporins No Longer a Recommended Treatment for Gonococcal Infections MMWR. 61: 590–593.
    1. Birkenmeyer L, Armstrong AS (1992) Preliminary evaluation of the ligase chain reaction for specific detection of Neisseria gonorrhoeae . J Clin Microbiol 30: 3089–3094.
    1. Goire N, Freeman K, Tapsall JW, Lambert SB, Nissen MD, et al. (2011) Enhancing gonococcal antimicrobial resistance surveillance: a real-time PCR assay for detection of penicillinase-producing Neisseria gonorrhoeae by use of noncultured clinical samples. J Clin Microbiol 49: 513–518.
    1. Li Z, Yokoi S, Kawamura Y, Maeda S, Ezaki T, et al. (2002) Rapid detection of quinolone resistance-associated gyrA mutations in Neisseria gonorrhoeae with a LightCycler. J Infect Chemother 8: 145–150.
    1. Magooa MP, Muller EE, Gumede L, Lewis DA (2013) Determination of Neisseria gonorrhoeae susceptibility to ciprofloxacin in clinical specimens from men using a real-time PCR assay. Int J Antimicrob Agents 42: 63–67.
    1. Balashov S, Mordechai E, Adelson ME, Gygax SE (2013) Multiplex bead suspension array for screening Neisseria gonorrhoeae antibiotic resistance genetic determinants in noncultured clinical samples. J Mol Diagn 15: 116–129.
    1. Goire N, Ohnishi M, Limnios AE, Lahra MM, Lambert SB, et al. (2012) Enhanced gonococcal antimicrobial surveillance in the era of ceftriaxone resistance: a real-time PCR assay for direct detection of the Neisseria gonorrhoeae H041 strain. J Antimicrob Chemother 67: 902–905.
    1. Smith R, Coast J (2013) The true cost of antimicrobial resistance. BMJ 346: f1493.

Source: PubMed

赞助者和合作者

医疗条件

药物干预

3
订阅