An Unsettling Surge in Multidrug-Resistant and Extensively Drug-Resistant Neisseria gonorrhoeae : Insights From a National Reference Centre for Sexually Transmitted Infections in India.

BACKGROUND: The rapidly evolving drug resistance of Neisseria gonorrhoeae to various drugs used in its treatment has posed significant challenges, especially in developing countries. A rise in cephalosporin minimum inhibitory concentrations (MIC) among N. gonorrhoeae was identified in parts of Asia, as early as the late 1990s. Drugs such as penicillin, tetracycline, and ciprofloxacin, which were effective in the past, are now almost never used in treating gonorrhea. This research aimed to study the resistance trends of N. gonorrhoeae over a temporal span of 5 years.

METHODS: For 5 years, samples from STI clinic attendees were collected and processed for isolating N. gonorrhoeae . Confirmed isolates were subjected to antimicrobial susceptibility tests using the MIC E-strip method.

RESULTS: A total of 231 isolates of N. gonorrhoeae were studied, with 97.5% from male patients. Decreased susceptibility to third-generation cephalosporins (cefixime and ceftriaxone) was 6.06%. Azithromycin resistance was reported in 13.4% of isolates, with three-fourths from the states of North India (Delhi and Chandigarh). Of these isolates, 22.5% showed high-level resistance to azithromycin. In addition, 16 isolates were multidrug-resistant, and 1 isolate was an extensively drug-resistant N. gonorrhoeae.

CONCLUSIONS: These findings highlight the urgent need for concerted efforts to address the burgeoning threat of antimicrobial resistance (AMR) in N. gonorrhoeae . Continued surveillance of drug resistance is crucial. Efforts should be made to explore novel, effective treatment options to resolve this issue.