Dataset Information

The Characteristics of Patients Frequently Tested and Repeatedly Infected with Neisseria gonorrhoeae.

ABSTRACT: We assessed whether patients repeatedly infected with Neisseria gonorrhoeae (NG) were different compared to patients repeatedly tested negative, to obtain insight into the characteristics of patients frequently tested and infected with NG. All patients tested for NG (n = 16,662) between January 2011 and July 2018 were included. Multivariable logistic regression analyses were performed for the outcomes "repeat NG infections" and "once NG positive and not retested" versus patients "repeatedly tested NG negative". Of the individuals tested for NG, 0.2% (40/16,662) had repeat (?2) NG infections, and accounted for 23% of all diagnosed NG infections. STI clinic patients, men (mostly men who have sex with men (MSM)), patients aged ?25 years, and patients co-infected with HIV or Chlamydia trachomatis (CT) more often had repeat NG infections. The number of patients not retested after their initial NG diagnosis was 29.9% (92/308). Men (mostly MSM), HIV positive patients, and patients notified for sexually transmitted infections (STIs) were more often NG positive and not retested. Concluding, only 40 patients tested for NG accounted for one in four diagnosed NG infections. However, re-infections are likely to be missed among MSM and HIV positive patients, as they were mainly not retested after NG infection. It remains important to test and re-test for NG, especially in MSM, in order to halt transmission.

SUBMITTER: Wijers J

PROVIDER: S-EPMC7084364 | biostudies-literature | 2020 Feb

REPOSITORIES: biostudies-literature

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The Characteristics of Patients Frequently Tested and Repeatedly Infected with <i>Neisseria gonorrhoeae</i>.

Wijers Juliën J Hoebe Christian C Dukers-Muijrers Nicole N Wolffs Petra P van Liere Geneviève G

International journal of environmental research and public health 20200226 5

We assessed whether patients repeatedly infected with <i>Neisseria gonorrhoeae</i> (NG) were different compared to patients repeatedly tested negative, to obtain insight into the characteristics of patients frequently tested and infected with NG. All patients tested for NG (n = 16,662) between January 2011 and July 2018 were included. Multivariable logistic regression analyses were performed for the outcomes "repeat NG infections" and "once NG positive and not retested" versus patients "repeated ...[more]

PMID: 32110902

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Project description:Many clinical isolates of the human pathogen Neisseria gonorrhoeae contain conjugative plasmids. The host range of these plasmids is limited to Neisseria species, but presence of a tetracycline (tetM) determinant inserted in several of these plasmids is an important cause of the rapid spread of tetracycline resistance. Previously plasmids with different backbones (Dutch and American type backbones) and with and without different tetM determinants (Dutch and American type tetM determinants) have been identified. Within the isolates tested, all plasmids with American or Dutch type tetM determinants contained a Dutch type plasmid backbone. This demonstrated that tetM determinants should not be used to differentiate between conjugal plasmid backbones. The nucleotide sequences of conjugative plasmids with Dutch type plasmid backbones either not containing the tetM determinant (pEP5233) or containing Dutch (pEP5289) or American (pEP5050) type tetM determinants were determined. Analysis of the backbone sequences showed that they belong to a novel IncP1 subfamily divergent from the IncP1alpha, beta, gamma, delta and epsilon subfamilies. The tetM determinants were inserted in a genetic load region found in all these plasmids. Insertion was accompanied by the insertion of a gene with an unknown function, and rearrangement of a toxin/antitoxin gene cluster. The genetic load region contains two toxin/antitoxins of the Zeta/Epsilon toxin/antitoxin family previously only found in Gram positive organisms and the virulence associated protein D of the VapD/VapX toxin/antitoxin family. Remarkably, presence of VapX of pJD1, a small cryptic neisserial plasmid, in the acceptor strain strongly increased the conjugation efficiency, suggesting that it functions as an antitoxin for the conjugative plasmid. The presence of the toxin and antitoxin on different plasmids might explain why the host range of this IncP1 plasmid is limited to Neisseria species. The isolated plasmids conjugated efficiently between N. gonorrhoeae strains, but did not enhance transfer of a genetic marker.

Project description:BackgroundAntimicrobial resistance (AMR) and genetic determinants of resistance of N. gonorrhoeae isolates from Hefei, China, were characterized adding a breadth of information to the molecular epidemiology of gonococcal resistance in China.Methods126 N. gonorrhoeae isolates from a hospital clinic in Hefei, were collected between January, 2014, and November, 2015. The minimum inhibitory concentration (MIC) of N. gonorrhoeae isolates for seven antimicrobials were determined by the agar dilution method. Isolates were tested for mutations in penA and mtrR genes and 23S rRNA, and also genotyped using N. gonorrhoeae multi-antigen sequence typing (NG-MAST).ResultsAll N. gonorrhoeae isolates were resistant to ciprofloxacin; 81.7% (103/126) to tetracycline and 73.8% (93/126) to penicillin. 39.7% (50/126) of isolates were penicillinase producing N. gonorrhoeae (PPNG), 31.7% (40/126) were tetracycline resistant N. gonorrhoeae (TRNG) and 28.6% (36/126) were resistant to azithromycin. While not fully resistant to extended spectrum cephalosporins (ESCs), a total of 14 isolates (11.1%) displayed decreased susceptibility to ceftriaxone (MIC ≥ 0.125 mg/L, n = 10), cefixime (MIC ≥ 0. 25 mg/L, n = 1) or to both ESCs (n = 3). penA mosaic alleles XXXV were found in all isolates that harbored decreased susceptibility to cefixime, except for one. Four mutations were found in mtrR genes and mutations A2143G and C2599T were identified in 23S rRNA. No isolates were resistant to spectinomycin. Gonococcal isolates were distributed into diverse NG-MAST sequence types (STs); 86 separate STs were identified.ConclusionsN. gonorrhoeae isolates from Hefei during 2014-2015, displayed high levels of resistance to antimicrobials that had been recommended previously for treatment of gonorrhea, e.g., penicillin, tetracycline and ciprofloxacin. The prevalence of resistance to azithromycin was also high (28.6%). No isolates were found to be fully resistant to spectinomycin, ceftriaxone or cefixime; however, 11.1% isolates, overall, had decreased susceptibility to ESCs.

Dataset Information

The Characteristics of Patients Frequently Tested and Repeatedly Infected with Neisseria gonorrhoeae.

Publications

The Characteristics of Patients Frequently Tested and Repeatedly Infected with <i>Neisseria gonorrhoeae</i>.

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