Introduction
Neisseria gonorrhoeae, an important pathogen of sexually transmitted infections, is resistant to all recommended antimicrobial agents, penicillins, tetracyclines, fluoroquinolones, oral third-generation cephalosporins and macrolides. Antimicrobial susceptibility surveillance of N. gonorrhoeae is needed to identify trends in its antimicrobial resistance. The fourth nationwide antimicrobial susceptibility surveillance of N. gonorrhoeae isolated from male urethritis was conducted by the Surveillance Committee of the Japanese Society of Infectious Diseases, the Japanese Society for Chemotherapy, and the Japanese Society of Clinical Microbiology.
Methods
Specimens of 1068 N. gonorrhoeae strains collected from male patients with or suspicious for urethritis at 50 facilities in 2021 were tested for antimicrobial susceptibility to 10 antimicrobial agents by CLSI methods.
Results
All strains were non-susceptible to penicillin G. The non-susceptible rate against cefixime was 7.4 %. At the Japanese dose, 39.6 % of strains were non-susceptible to cefixime. No strain was non-susceptible to ceftriaxone and spectinomycin. Susceptibility rates were ciprofloxacin, 24.7 %; tetracycline, 13.7 %; and azithromycin, 89.0 %. Only 0.47 % of isolated strains were resistant to all of cefixime, azithromycin, and ciprofloxacin. However, at the Japanese dose breakpoint, 31.8 % of strains were susceptible against azithromycin and 15.6 % of strains showed resistant to all of cefixime, azithromycin, and ciprofloxacin. Non-susceptibility rates against cefixime tended to be higher than the national average in Hokkaido, Kinki-Chugoku-Shikoku, and Tokai-Hokuriku regions, whereas those against ciprofloxacin tended to be higher in Kanto and Tokai-Hokuriku regions.
Conclusion
From these results, monotherapy with ceftriaxone or spectinomycin, which is currently recommended in Japanese guidelines for gonococcal infection, is considered appropriate. Continued gonococcal antimicrobial susceptibility surveillance is needed.
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