Antimicrobial resistance (AMR) in Neisseria gonorrhoeae is a global concern. Phylogenetic analyses resolve uncertainties regarding genetic relatedness of isolates with identical phenotypes and inform whether AMR is due to new mutations and clonal expansion or separate introductions by importation. We sequenced 1,277 isolates with associated epidemiologic and antimicrobial susceptibility data collected during 2013-2016 to investigate N. gonorrhoeae genomic variability in England. Comparing genetic markers and phenotypes for AMR, we identified 2 N. gonorrhoeae lineages with different antimicrobial susceptibility profiles and 3 clusters with elevated MICs for ceftriaxone, varying mutations in the penA allele, and different epidemiologic characteristics. Our results indicate N. gonorrhoeae with reduced antimicrobial susceptibility emerged independently and multiple times in different sexual networks in England, through new mutation or recombination events and by importation. Monitoring and control for AMR in N. gonorrhoeae should cover the entire population affected, rather than focusing on specific risk groups or locations.
Bibliographical noteFunding Information:
We thank our funders, the Blood-Borne and Sexually Transmitted Infections Steering Committee of the National Institute for Health Research Health Protection Research Unit (NIHR HPRU), Caroline Sabin, Anthony Nardone, Catherine Mercer, Gwenda Hughes, Jackie Cassell, Greta Rait, Samreen Ijaz, Tim Rhodes, Kholoud Porter, Sema Mandal, and William Rosenberg; the Wellcome Trust (grant no. 098051); and Public Health England. We also thank the clinical and laboratory staff who contributed to GRASP and Hester Allen for her help with data management and analysis.
This research was funded by the National Institute for Health Research (NIHR) Health Protection Research Unit in Blood Borne and Sexually Transmitted Infections at University College London in partnership with Public Health England, in collaboration with the London School of Hygiene & Tropical Medicine. The views expressed are those of the authors and not necessarily those of the NIHR, the Department of Health and Social Care, or Public Health England.
Open Access: No Open Access licence.
Publisher Copyright: © 2020 Centers for Disease Control and Prevention (CDC). All rights reserved.
Citation: Town K, Harris S, Sánchez-Busó L, Cole MJ, Pitt R, Fifer H, et al. Genomic and Phenotypic Variability in Neisseria gonorrhoeae Antimicrobial Susceptibility, England. Emerg Infect Dis. 2020;26(3):505-515.