Gonococcal antibiotic surveillance in Scotland (GASS): prevalence, patterns and trends in 2018

The Gonococcal Antibiotic Surveillance in Scotland (GASS) report, published on 28 May 2019 by the Scottish Bacterial Sexually Transmitted Infection Reference Laboratory (SBSTIRL) and Health Protection Scotland (HPS), shows the patterns and trends of antibiotic resistance in 2018.

As outlined in the report of genital chlamydia and gonorrhoea diagnoses for 2009-2018, the number of gonorrhoea episodes reported in Scotland increased by 24% to 3,233 in 2018. From the resistance surveillance data available, it would appear that, in 2018, the proportion of isolates resistant to ciprofloxacin remained steady at 35%.

Decreased susceptibility to azithromycin was recorded in 7.0% of isolates and, of particular concern, was the increase in the proportion of isolates with high-level resistance to azithromycin (rising from 1.6% in 2017 to 2.1% in 2018). Encouragingly, however, no treatment failures have been formally reported. Also of note is one patient who was recorded as having resistance to both ceftriaxone and cefixime in 2018. This isolate was also resistant to ciprofloxacin, but susceptible to azithromycin.

Given the changing resistance patterns observed in Scotland, across the UK and in Europe particularly, UK guidelines for the treatment of gonococcal infection were updated during 2019, from azithromycin and ceftriaxone dual therapy to ceftriaxone monotherapy as the first-line treatment. Continued surveillance of antibiotic resistance is essential for guiding effective therapeutic regimens in light of the continuing rise in gonorrhoea infection.