Trends and regional variations of gonococcal antimicrobial resistance in the Netherlands, 2013 to 2019

Background: Gonococcal antimicrobial resistance is emerging worldwide and is monitored in the Netherlands in 18 of 24 Sexual Health Centres (SHC). Aim: To report trends, predictors and regional variation of gonococcal azithromycin resistance (AZI-R, minimum inhibitory concentration (MIC) ) 1 mg/L) and ceftriaxone decreased susceptibility (CEF-DS, MIC ) 0.032 mg/L) in 2013-2019. Methods: SHC reported data on indi-vidual characteristics, sexually transmitted infection diagnoses, and susceptibility testing (MIC, measured by Etest). We used multilevel logistic regression analy-sis to identify AZI-R/CEF-DS predictors, correcting for SHC region. Population differences' effect on regional variance of AZI-R and CEF-DS was assessed with a separate multilevel model. Results: The study included 13,172 isolates, predominantly (n = 9,751; 74%) from men who have sex with men (MSM). Between 2013 and 2019, annual proportions of AZI-R isolates appeared to increase from 2.8% (37/1,304) to 9.3% (210/2,264), while those of CEF-DS seemed to decrease from 7.0% (91/1,306) to 2.9% (65/2,276). Among SHC regions, 0.0-16.9% isolates were AZI-R and 0.0-7.0% CEF-DS; population characteristics could not explain regional variance. Pharyngeal strain origin and consultation year were significantly associated with AZI-R and CEF-DS for MSM, women, and heterosexual men. Among women and heterosexual men ??? 4 partners was associated with CEF-DS, and ??? 10 with AZI-R. Conclusions: No resist-ance or decreasing susceptibility was found for CEF, the first line gonorrhoea treatment in the Netherlands. Similar to trends worldwide, AZI-R appeared to increase. Regional differences between SHC support nationwide surveillance with regional-level reporting. The increased risk of resistance/decreased susceptibil-ity in pharyngeal strains underlines the importance of including extragenital infections in gonococcal resist-ance surveillance.

Automated summary

This study investigated the trends and regional variation of gonococcal azithromycin resistance and ceftriaxone decreased susceptibility in the Netherlands from 2013 to 2019. Azithromycin resistance appeared to increase while ceftriaxone decreased susceptibility seemed to decrease. Individual characteristics, sexually transmitted infection diagnoses, and resistance testing results were associated with resistance and decreased susceptibility.