The Lancet Regional Health. Western Pacific (Aug 2025)

Antimicrobial resistance in Neisseria gonorrhoeae in nine sentinel countries within the World Health Organization Enhanced Gonococcal Antimicrobial Surveillance Programme (EGASP), 2023: a retrospective observational studyResearch in context

  • Ismael Maatouk,
  • Phiona Vumbugwa,
  • Thitima Cherdtrakulkiat,
  • Lon Say Heng,
  • Irving Hoffman,
  • Noel Palaypayon,
  • Francis Kakooza,
  • Rossaphorn Kittiyaowamarn,
  • Peter Kyambadde,
  • Monica M. Lahra,
  • Pham Thi Lan,
  • Venessa Maseko,
  • Mitch Matoga,
  • Anna Machiha,
  • Etienne Müller,
  • Thuy Thi Phan Nguyen,
  • Le Huu Doanh,
  • Vichea Ouk,
  • Vivi Setiawaty,
  • Sonia B. Sia,
  • Teguh S. Hartono,
  • Mot Virak,
  • Nguyen Thi Thuy Van,
  • Magnus Unemo,
  • Teodora Wi,
  • Lon Say Heng,
  • Vichea Ouk,
  • Mot Virak,
  • Phal Kun Mom,
  • Serongkea Deng,
  • Vivi Setiawaty,
  • Endang Lukitosari,
  • Nurhalina Afriana,
  • Verawati Sulaiman,
  • Teguh S. Hartono,
  • Maria Laurensia,
  • Ni Luh Putu Pitawati,
  • Mitch Matoga,
  • Irving Hoffman,
  • Robert Krysiak,
  • Jane Chen,
  • Naomi Bonongwe,
  • Claightone Chirombo,
  • Edward Jere,
  • James Kapha,
  • Sonia B. Sia,
  • Manuel C. Jamoralin, Jr.,
  • Marietta Lagrada,
  • June Gayeta,
  • Jaywardeen Abad,
  • Noel Palaypayon,
  • Diana Lim,
  • Iftizar N. Haron,
  • Joseph Carlo Sangco,
  • Felyrose Fuertes,
  • August Cesar Abrajano,
  • Ruby Rusia-Uy,
  • Christine Ivy Paula S. Agtuca,
  • Ma. Theresa A. Fedoc-Minguito,
  • Louwela A. Jerusalem,
  • Venessa Maseko,
  • Etienne Müller,
  • Lindy Gumede,
  • Portia Baloyi,
  • Rossaphorn Kittiyaowamarn,
  • Natnaree Girdthep,
  • Porntip Paopang,
  • Pongsathorn Sangprasert,
  • Thitima Cherdtrakulkiat,
  • Jaray Tongtoyai,
  • Francis Kakooza,
  • Peter Kyambadde,
  • Emmanuel Mande,
  • Martha Nakasi,
  • Le Huu Doanh,
  • Pham Thi Lan,
  • Pham Quynh Hoa,
  • Pham Dieu Hoa,
  • Thuy Thi Phan Nguyen,
  • Hao Trong Nguyen,
  • Nhi Thi Uyen Pham,
  • Phuong Thi Thanh Nguyen,
  • Nguyen Thi Thuy Van,
  • Francis Slaughter,
  • Anna Machiha,
  • Owen Mugurungi,
  • Agnes Juru,
  • Tatenda Ngorima,
  • Lucia Sisya,
  • Kudzai Takarinda,
  • Andrew Tarupiwa,
  • Muchaneta Mugabe,
  • Mkhokheli Ngwenya,
  • Precious Paidamoyo Andifasi,
  • Monica Lahra,
  • Sebastian van Hal,
  • Magnus Unemo,
  • Daniel Golparian,
  • Susanne Jacobsson,
  • Daniel Schröder,
  • Teodora Wi,
  • Ismael Maatouk,
  • Phiona Vumbugwa

DOI
https://doi.org/10.1016/j.lanwpc.2025.101663
Journal volume & issue
Vol. 61
p. 101663

Abstract

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Summary: Background: The global spread of antimicrobial resistance (AMR) in Neisseria gonorrhoeae threatens empiric single-dose gonorrhoea treatment. Enhanced global AMR surveillance is imperative. We report i) gonococcal antimicrobial susceptibility and resistance data from 2023 in the World Health Organization Enhanced Gonococcal Antimicrobial Surveillance Programme (WHO EGASP) in the WHO Western Pacific Region (Cambodia, the Philippines, Viet Nam), Southeast Asian Region (Indonesia, Thailand), and African Region (Malawi, South Africa, Uganda, Zimbabwe), and ii) metadata of the gonorrhoea patients. Methods: In 2023, WHO EGASP included men with urethral discharge (n = 3498) and gonococcal isolates (n = 2491). Minimum inhibitory concentrations (MICs, mg/L) values were determined for ceftriaxone, cefixime, azithromycin, gentamicin, and ciprofloxacin using Etest (bioMérieux). Breakpoints from the European Committee on Antimicrobial Susceptibility Testing (EUCAST) were applied. Clinical and epidemiological variables associated with AMR isolates were assessed using univariable and multivariable logistic regression analyses of odds ratios. Findings: Overall, 3.8% (95% confidence interval (95% CI) 3.1–4.6%; 95/2487), 8.9% (95% CI 7.9–10.1%; 222/2484), 3.6% (95% CI 2.9–4.4%; 89/2487), and 95.3% (95% CI 93.2–97.5%; 1801/1890) of isolates were resistant to ceftriaxone, cefixime, azithromycin, and ciprofloxacin, respectively. All the ceftriaxone-resistant isolates were from Cambodia (15.3% (95% CI 11.5–20.1%), 42/274) and Viet Nam (20.4% (95% CI 15.9–25.7%), 53/260). In univariable analysis, ceftriaxone resistance was associated with travelling within the country during previous 30 days (OR 4.66, 95% CI 3.06–7.16; p < 0.001), and this association remained in multivariable analysis (aOR 4.12, 95% CI 2.65–6.65; p < 0.001). Interpretation: Resistance to ceftriaxone, cefixime, and azithromycin is a major global concern, and expanded and improved resistance surveillance is essential. The WHO EGASP has been substantially expanded in the recent years. Additionally, resistance breakpoints have been harmonised and test-of-cure, whole-genome sequencing, and extragenital sampling implemented, where feasible. Novel antimicrobials for gonorrhoea treatment are critical; zoliflodacin and gepotidacin are promising. Funding: WHO, Global Fund.

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