Gonococcal antimicrobial susceptibility surveillance in the EU/ EEA

In 2022, the European Gonococcal Antimicrobial Surveillance Programme (Euro-GASP) conducted an annual decentralised and centralised testing model, collecting gonococcal isolates from 23 EU/EEA countries. The majority of specimens were from male patients (80.9%), aged between one and 75 years. The anatomical sites of specimen collection were mainly genital (69.0%), followed by rectal (17.8%) and pharyngeal (12.0%). The 2022 Euro-GASP results revealed a total of 0.3% of gonococcal isolates with resistance to cefixime (MIC>0.125 mg/L). The European Committee on Antimicrobial Susceptibility Testing (EUCAST) clinical resistance breakpoint for azithromycin was replaced with an epidemiological cut-off (ECOFF) value of MIC>1 mg/L in January 2019. The proportion of isolates showing resistance to ciprofloxacin substantially increased, reaching 65.9% in 2022 compared to 62.8% and 2020 (57.7%). The European treatment guideline was updated in 2020 to recommend high-dose ceftriaxone plus azithromycin dual therapy or ceftriaxone high-dose monotherapy. Despite the decrease in cefixime resistance, it is crucial to monitor and develop alternative gonococcal regimens to ensure gonorrhoea remains a treatable infection.