The Molecular Epidemiology and Antimicrobial Resistance of Neisseria gonorrhoeae in Australia: A Nationwide Cross-Sectional Study, 2012.
BACKGROUND
Antimicrobial resistance (AMR) by Neisseria gonorrhoeae is considered a serious global threat.


METHODS
In this nationwide study, we used MassARRAY iPLEX genotyping technology to examine the epidemiology of N. gonorrhoeae and associated AMR in the Australian population. All available N. gonorrhoeae isolates (n = 2452) received from Australian reference laboratories from January to June 2012 were included in the study. Genotypic data were combined with phenotypic AMR information to define strain types.


RESULTS
A total of 270 distinct strain types were observed. The 40 most common strain types accounted for over 80% of isolates, and the 10 most common strain types accounted for almost half of all isolates. The high male to female ratios (>94% male) suggested that at least 22 of the top 40 strain types were primarily circulating within networks of men who have sex with men (MSM). Particular strain types were also concentrated among females: two strain types accounted for 37.5% of all isolates from females. Isolates harbouring the mosaic penicillin binding protein 2 (PBP2)-considered a key mechanism for cephalosporin resistance-comprised 8.9% of all N. gonorrhoeae isolates and were primarily observed in males (95%).


CONCLUSIONS
This large scale epidemiological investigation demonstrated that N. gonorrhoeae infections are dominated by relatively few strain types. The commonest strain types were concentrated in MSM in urban areas and Indigenous heterosexuals in remote areas, and we were able to confirm a resurgent epidemic in heterosexual networks in urban areas. The prevalence of mosaic PBP2 harboring N. gonorrhoeae strains highlight the ability for new N. gonorrhoeae strains to spread and become established across populations.
UQ Centre for Clinical Research, The University of Queensland, Brisbane.
Ella
E
Trembizki
Kirby Institute, UNSW Australia, Sydney.
Handan
H
Wand
Kirby Institute, UNSW Australia, Sydney.|Sydney Sexual Health Centre, Sydney Hospital, New South Wales.
Basil
B
Donovan
Melbourne Sexual Health Centre, Alfred Health, Carlton.|Central Clinical School Monash University, Melbourne, Victoria.
Marcus
M
Chen
Melbourne Sexual Health Centre, Alfred Health, Carlton.|Central Clinical School Monash University, Melbourne, Victoria.
Christopher K
CK
Fairley
Microbiology Laboratory, Pathology Department, Royal Darwin Hospital, Northern Territory.
Kevin
K
Freeman
Kirby Institute, UNSW Australia, Sydney.
Rebecca
R
Guy
Kirby Institute, UNSW Australia, Sydney.
John M
JM
Kaldor
WHO Collaborating Centre for STD, Microbiology Department, South Eastern Area Laboratory Services, Prince of Wales Hospital, Sydney, New South Wales.
Monica M
MM
Lahra
Microbiology and Infectious Diseases Department, Women's and Children's Hospital, North Adelaide, South Australia.
Andrew
A
Lawrence
Department of Global Health, Research School of Population Health, The Australian National University, Canberra, Australian Capital Territory.
Colleen
C
Lau
PathWest Laboratory Medicine-WA, Royal Perth Hospital, Western Australia.
Julie
J
Pearson
Kirby Institute, UNSW Australia, Sydney.
David G
DG
Regan
Kirby Institute, UNSW Australia, Sydney.|HNE Sexual Health, Hunter New England Local Health District, New South Wales.
Nathan
N
Ryder
Public Health Microbiology, Communicable Disease, Queensland Health Forensic and Scientific Services, Archerfield.
Helen
H
Smith
Microbiological Diagnostic Unit, Public Health Laboratory, Department of Microbiology and Immunology, The University of Melbourne, at The Peter Doherty Institute for Infection and Immunity, Victoria.
Kerrie
K
Stevens
Sexual Health and Blood Borne Virus Unit, Centre for Disease Control, Darwin, Northern Territory.
Jiunn-Yih
JY
Su
South Australian Health and Medical Research Institute, Adelaide, South Australia.
James
J
Ward
UQ Centre for Clinical Research, The University of Queensland, Brisbane.|Pathology Queensland Central Laboratory, Herston, Australia.
David M
DM
Whiley
D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D005260:Female; D060005:Genotyping Techniques; D006069:Gonorrhea / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D018451:Homosexuality, Male; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D017720:Molecular Epidemiology; D009344:Neisseria gonorrhoeae / Q000187:drug effects* / Q000235:genetics; D020641:Polymorphism, Single Nucleotide; D013045:Species Specificity
D000900:Anti-Bacterial Agents
gonorrhea; molecular; resistance; surveillance; typing