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ObjectivesTreatment of Neisseria gonorrhoeaeis threatened by the emergence of antimicrobial resistance. We analysed data from the Gonococcal Resistance to Antimicrobials Surveillance Programme (GRASP) in England and Wales to identify groups most at risk of reduced susceptibility to the currently recommended first-line therapy, ceftriaxone.MethodsData from GRASP between 2007 and 2013 on ceftriaxone susceptibility and strain types were analysed. Risk factors associated with isolates exhibiting a ceftriaxone minimum inhibitory concentration (MIC) of ≥0.015 mg/L (CTR ≥0.015 mg/L) were identified using logistic regression.ResultsOne third of isolates from men who have sex with men (MSM) (1279/4203) and 9.9% from heterosexuals (458/4626) exhibited CTR ≥0.015 mg/L. Between 2007 and 2013, the modal MIC for isolates remained at 0.004 mg/L for MSM but increased from 0.002 to 0.004 mg/L for heterosexuals. Among MSM, CTR ≥0.015 mg/L was associated with Asian ethnicity (crude OR: 1.42; 95% CI 1.07 to 1.88) and previous gonorrhoea (1.34; 1.16 to 1.54). Among heterosexuals, CTR ≥0.015 mg/L was associated with older age (35+ years: 4.31; 3.34 to 5.55), ≥6 sexual partners (1.58; 1.01 to 2.44) and sex abroad (2.23; 1.71 to 2.91). CTR ≥0.015 mg/L was less likely in isolates from heterosexuals of black Caribbean or African ethnicity (0.29; 0.20 to 0.41, 0.66; 0.43 to 0.99), with a concurrent chlamydial infection (0.25; 0.19 to 0.34) or women (0.57; 0.46 to 0.71). Over 600 isolates (CTR ≥0.015 mg/L) were typed; the majority were in Genogroup 1407, containing sequence type 1407.ConclusionsThe emergence and spread of gonorrhoea with reduced susceptibility to ceftriaxone seems a realistic prospect, most likely in those involved in ‘rapid-transmission’ or bridging sexual networks.

IntroductionAn outbreak of high-level azithromycin resistant gonorrhoea, dubbed ‘super gonorrhoea’ in the mainstream media, emerged in Leeds, England in 2015 and has since spread to other parts of the country. We aimed to determine if media coverage affected online searches nationally and attendances, and gonorrhoea testing and diagnoses locally at sexual health clinics (SHCs).MethodsGoogle Trends was used to determine Relative Search Interest (RSI) for ‘gonorrh*’ and ‘super gonorrh*’ in England from 2015–2016. Using data from England’s national STI surveillance system (GUMCADv2), an interrupted time series analysis was performed to compare the sex-stratified, weekly rates of attendances, and gonorrhoea testing and diagnoses at 6 SHCs in Leeds and in other affected areas. The analysis compared rates of events 6 weeks before and after initial media coverage of the outbreak in September 2015.ResultsThe RSI peaked during initial media coverage in September 2015 (100) with smaller peaks in December 2015 (47), April 2016 (72), and September 2016 (33), coinciding with subsequent coverage. The number of SHC attendances by women in Leeds rose after initial media coverage (p<0.01) by 36% (from 320 to 435/week), but there was only a 4% increase in attendances (from 326 to 340/week) by men (p=0.70). There was no change in rates of gonorrhoea tests or diagnoses in women (p=0.87 and 0.23) or men (p=0.51 and p=1.00). There were no significant increases in event rates in other areas with a high RSI including Birmingham, Manchester, London, Liverpool and Sheffield. ConclusionMedia coverage of the outbreak was associated temporally with increased online searches for gonorrhoea nationally, and female attendances at SHCs in Leeds only. This demonstrates opportunities for health promotion for the prevention and control of outbreaks and raises the question of how best to target such messaging to those populations and groups most likely to benefit from attending and being tested in SHCs.