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Molecular surveillance of neisseria gonorrhoeae antimicrobial resistance

Recent emergence of extensively drug-resistant (XDR) Neisseria gonorrhoeae strains in Japan and Europe raise concerns that gonorrhoea may soon become difficult-to-treat. Enhancing antimicrobial resistance (AMR) surveillance strategies is a public health priority. Whilst bacterial culture-based methods remain the most definitive means of assessing N. gonorrhoeae AMR, there has been decreasing availability of cultured isolates for AMR susceptibility testing owing to increased use of nucleic acid amplification test (NAAT)-based methods for gonorrhoea diagnosis. Isolation of viable N. gonorrhoeae from specimens collected in remote communities is also difficult owing to prolonged specimen transport times. Molecular AMR surveillance tools have the potential to overcome these problems. In particular, polymerase chain reaction-based methods targeting key genetic markers of resistance can facilitate rapid, more intense sampling of resistant N. gonorrhoeae strains following NAAT-based diagnosis.