One confirmed and one suspected case of pharyngeal gonorrhoea treatment failure following 500 mg ceftriaxone in Sydney, Australia
Phillip J. Read A B F , E. Athena Limnios C , Anna McNulty A D , David Whiley E and Monica M. Lahra CA Sydney Sexual Health Centre, GPO Box 1614, Sydney, NSW 2001, Australia.
B The Kirby Institute, University of New South Wales, Sydney, NSW 2052, Australia.
C World Health Organisation Collaborating Centre for STDs, Prince of Wales Hospital, Sydney, NSW 2031, Australia.
D School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW 2052, Australia.
E Queensland Paediatric Infectious Diseases Laboratory, Queensland Children’s Medical Research Institute, The University of Queensland, Brisbane, Qld 4006, Australia.
F Corresponding author. Email: phillip.read@sesiahs.health.nsw.gov.au
Sexual Health 10(5) 460-462 https://doi.org/10.1071/SH13077
Submitted: 18 May 2013 Accepted: 3 July 2013 Published: 13 September 2013
Abstract
Emerging antimicrobial resistance within Neisseria gonorrhoeae (NG) is a significant global public health threat. Detection and investigation of treatment failures is a crucial component of the World Health Organisation’s response to this challenge. We report the cases of two homosexual men, both treated for pharyngeal NG with 500 mg intramuscular ceftriaxone, in whom a test of cure 1 week after treatment showed persisting infection. Both men denied further sexual activity. In the first case, treatment failure was confirmed, since the isolates before and after treatment were identical by auxotype, antibiogram, multilocus sequence type (MLST) and multi-antigen sequence type (NG-MAST). In the second case, the MLSTs before and after treatment were identical, but NG-MAST results were similar but not indistinguishable. These cases underline the importance of test-of-cure and molecular investigations in identifying treatment failure, but also highlight the complexity of distinguishing treatment failure from reinfection when relying on highly variable molecular targets that may be subject to drug pressure.
Additional keywords: cephalosporin, drug resistance, multiantigen sequence type, multilocus sequence type.
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