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JAC Advance Access originally published online on June 13, 2008
Journal of Antimicrobial Chemotherapy 2008 62(3):490-494; doi:10.1093/jac/dkn235
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© The Author 2008. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Original research

Emergence and spread of azithromycin-resistant Neisseria gonorrhoeae in Scotland

Helen M. Palmer1,*, Hugh Young1, Andrew Winter2 and Jayshree Dave1

1 Scottish Bacterial Sexually Transmitted Infections Reference Laboratory (SBSTIRL), Department of Medical Microbiology, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 5SA, UK 2 Sandyford Initiative, 2-6 Sandyford Place, Glasgow G3 7NB, UK

Received 19 March 2008; returned 16 April 2008; revised 16 May 2008; accepted 20 May 2008

* Corresponding author. Tel: +44-131-242-6077; Fax: +44-131-242-6008; E-mail: helen.palmer{at}luht.scot.nhs.uk

Objectives: The aim of this study was to analyse the trend in azithromycin susceptibility (AzDS) of Neisseria gonorrhoeae in Scotland between April 2004 and December 2007, and to characterize isolates exhibiting decreased AzDS or high-level azithromycin resistance (AzHLR).

Methods: Antibiotic susceptibility testing and N. gonorrhoeae multiantigen sequence typing (NG-MAST) were performed on all gonococcal isolates received by the Scottish Bacterial Sexually Transmitted Infections Reference Laboratory (SBSTIRL) during the study period.

Results: AzHLR isolates were observed for the first time in 2004 and increased from 0.3% to 3.9% in 2007. AzDS declined from 2.1% to 1.3% in the same period. Taken together, AzDS and AzHLR isolates accounted for 5.2% of the gonococcal infections in Scotland in 2007. NG-MAST revealed that only a small number of sequence types (STs) contained AzHLR and AzDS isolates; these STs also included azithromycin-susceptible isolates. Most STs containing AzHLR isolates were genetically related on the basis of their por and tbpB alleles; however, demographic data suggested that they formed discrete sexual networks.

Conclusions: AzHLR strains of N. gonorrhoeae are increasing in Scotland. A 1 g dose of azithromycin should not be considered as an alternative antibiotic therapy for gonococcal infections. The use of azithromycin to treat chlamydia in patients co-infected with N. gonorrhoeae results in a level of azithromycin in vivo that is sublethal for N. gonorrhoeae, which may lead to resistance.

Keywords: chlamydia , co-infection , epidemiology , molecular typing , NG-MAST


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