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Phenotypic and genotypic properties of Neisseria gonorrhoeae isolates in Norway in 2009: antimicrobial resistance warrants an immediate change in national management guidelines

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Abstract

Despite rapidly diminishing treatment options for Neisseria gonorrhoeae and high levels of ciprofloxacin resistance worldwide, Norwegian guidelines still recommend ciprofloxacin as empirical treatment for gonorrhea. The present study aimed to characterize phenotypical and genotypical properties of N. gonorrhoeae isolates in Norway in 2009. All viable N. gonorrhoeae isolates (n = 114) from six university hospitals in Norway (2009) were collected, representing 42% of all notified gonorrhea cases. Epidemiological data were collected from the Norwegian Surveillance System for Communicable Diseases and linked to phenotypical and genotypical characteristics for each N. gonorrhoeae isolate. Resistance levels to the antimicrobials examined were: ciprofloxacin 78%, azithromycin 11%, cefixime 3.5%, ceftriaxone 1.8%, and spectinomycin 0%. The minimum inhibitory concentrations of gentamicin varied from 1.5 to 8 mg/L. Forty-one (36%) of the isolates were β-lactamase-producing, 17 displayed penA mosaic alleles, and 72 different N. gonorrhoeae multiantigen sequence types (ST; 37 novel) were identified. The most common ST was ST1407 (n = 11), containing penA mosaic allele. Four of these isolates displayed intermediate susceptibility/resistance to cefixime. The N. gonorrhoeae strains circulating in Norway were highly diverse. The level of ciprofloxacin resistance was high and the Norwegian management guidelines should promptly exclude ciprofloxacin as an empirical treatment option for gonorrhea.

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Acknowledgements

This work was financially supported by the Örebro County Council Research Committee, the Foundation for Medical Research at Örebro University Hospital, Sweden, and the University of Tromsø, Tromsø, Norway. The collection of isolates and initial diagnosis was performed and funded by the participating University hospitals as part of their routine diagnosis.

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Authors and Affiliations

  1. Department of Microbiology and Infection Control, University Hospital of North Norway, P.O. Box 56, 9038, Tromsø, Norway

    S. O. Hjelmevoll

  2. National Reference Laboratory for Pathogenic Neisseria, Department of Laboratory Medicine, Microbiology, Örebro University Hospital, Örebro, Sweden

    D. Golparian & M. Unemo

  3. Department of Microbiology, Oslo University Hospital, Ullevål, Oslo, Norway

    L. Dedi

  4. Department of Microbiology, Haukeland University Hospital, Bergen, Norway

    D. H. Skutlaberg

  5. Department of Medical Microbiology, Stavanger University Hospital, Stavanger, Norway

    E. Haarr

  6. Department of Microbiology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway

    A. Christensen

  7. Department of Microbiology, Akershus University Hospital, Oslo, Norway

    S. Jørgensen

  8. Department of Infectious Disease Epidemiology, Norwegian Institute of Public Health, Oslo, Norway

    Ø. J. Nilsen

  9. Department of Medicine, University Hospital of North Norway, Tromsø, Norway

    V. Skogen

  10. Institute of Clinical Medicine, University of Tromsø, Tromsø, Norway

    V. Skogen

Authors
  1. S. O. Hjelmevoll
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  2. D. Golparian
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  3. L. Dedi
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  4. D. H. Skutlaberg
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  5. E. Haarr
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  6. A. Christensen
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  7. S. Jørgensen
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  8. Ø. J. Nilsen
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  9. M. Unemo
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  10. V. Skogen
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Corresponding author

Correspondence to S. O. Hjelmevoll.

Additional information

The present study was performed at the National Reference Laboratory for Pathogenic Neisseria, Örebro University Hospital, Örebro, Sweden and at the Department of Microbiology, University Hospital of North Norway, Tromsø, Norway. The project was funded by Örebro University Hospital (Magnus Unemo) and University of Tromsø (Vegard Skogen).

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Hjelmevoll, S.O., Golparian, D., Dedi, L. et al. Phenotypic and genotypic properties of Neisseria gonorrhoeae isolates in Norway in 2009: antimicrobial resistance warrants an immediate change in national management guidelines. Eur J Clin Microbiol Infect Dis 31, 1181–1186 (2012). https://doi.org/10.1007/s10096-011-1426-4

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  • DOI: https://doi.org/10.1007/s10096-011-1426-4

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