{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T21:57:03Z","timestamp":1785621423595,"version":"3.56.0"},"reference-count":49,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2024,3,22]],"date-time":"2024-03-22T00:00:00Z","timestamp":1711065600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"UK Health Security Agency"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,5,2]]},"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n Antimicrobial resistance in Neisseria gonorrhoeae is a global public health concern. Tetracycline resistance (TetR) increased from 39.4% to 75.2% between 2016 and 2021 in N. gonorrhoeae isolates collected through national surveillance in England, despite the absence of use of tetracyclines for the treatment of gonorrhoea.<\/jats:p>\n <\/jats:sec>\n \n Objectives<\/jats:title>\n We investigated whether there was correlation between bacterial sexually transmitted infection (STI) tests performed and treatment with antimicrobials, with increased TetR in N. gonorrhoeae.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n We examined correlations between bacterial STI tests, antimicrobial treatment and TetR in N. gonorrhoeae, using national surveillance data from three large sexual health services (SHS) in London during 2016\u201320. Doxycycline prescribing data and antibiograms of a non-STI pathogen from distinct patient groups (sexual health, obstetric and paediatric), at a large London hospital, were analysed to identify if doxycycline use in SHS was associated with resistance in a non-STI organism.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n A substantial increase in TetR was observed, particularly in isolates from gay, bisexual and other MSM (GBMSM). Strong positive correlations were observed exclusively in GBMSM between N. gonorrhoeae TetR and both bacterial STI tests (r\u200a=\u200a0.97, P\u200a=\u200a0.01) and antimicrobial treatment (r\u200a=\u200a0.87, P\u200a=\u200a0.05). Doxycycline prescribing increased dramatically during the study period in SHS. Prevalence of TetR in Staphylococcus aureus was higher in isolates sourced from SHS attendees than those from other settings.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Frequent screening of GBMSM at higher risk of STIs, such as those on pre-exposure prophylaxis (PrEP) leading to\/and increased use of doxycycline for the treatment of diagnosed infections, may account for the increase in TetR in N. gonorrhoeae.<\/jats:p>\n <\/jats:sec>","DOI":"10.1093\/jac\/dkae073","type":"journal-article","created":{"date-parts":[[2024,3,22]],"date-time":"2024-03-22T16:25:39Z","timestamp":1711124739000},"page":"1060-1068","source":"Crossref","is-referenced-by-count":8,"title":["Investigating the cause of increased tetracycline-resistant Neisseria gonorrhoeae<\/i> in England, 2016\u201320"],"prefix":"10.1093","volume":"79","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3524-5935","authenticated-orcid":false,"given":"Rachel","family":"Pitt-Kendall","sequence":"first","affiliation":[{"name":"UK Health Security Agency , London , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suzy","family":"Sun","sequence":"additional","affiliation":[{"name":"UK Health Security Agency , London , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0315-3603","authenticated-orcid":false,"given":"Stephen","family":"Hughes","sequence":"additional","affiliation":[{"name":"Chelsea & Westminster NHS Foundation Trust , London , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel","family":"Merrick","sequence":"additional","affiliation":[{"name":"UK Health Security Agency , London , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hugo","family":"Donaldson","sequence":"additional","affiliation":[{"name":"Chelsea & Westminster NHS Foundation Trust , London , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Rayment","sequence":"additional","affiliation":[{"name":"Chelsea & Westminster NHS Foundation Trust , London , UK"},{"name":"Imperial College London , London , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zdravko","family":"Ivanov","sequence":"additional","affiliation":[{"name":"UK Health Security Agency , London , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5089-2321","authenticated-orcid":false,"given":"Michaela","family":"Day","sequence":"additional","affiliation":[{"name":"UK Health Security Agency , London , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aisha","family":"Bari","sequence":"additional","affiliation":[{"name":"North West London Pathology , London , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monica","family":"Rebec","sequence":"additional","affiliation":[{"name":"North West London Pathology , London , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emma","family":"Callan","sequence":"additional","affiliation":[{"name":"UK Health Security Agency , London , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hamish","family":"Mohammed","sequence":"additional","affiliation":[{"name":"UK Health Security Agency , London , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katy","family":"Sinka","sequence":"additional","affiliation":[{"name":"UK Health Security Agency , London , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6707-6910","authenticated-orcid":false,"given":"Michelle","family":"Cole","sequence":"additional","affiliation":[{"name":"UK Health Security Agency , London , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helen","family":"Fifer","sequence":"additional","affiliation":[{"name":"UK Health Security Agency , London , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2024,3,22]]},"reference":[{"key":"2024050202520995000_dkae073-B1","author":"Public Health England"},{"key":"2024050202520995000_dkae073-B2","doi-asserted-by":"crossref","first-page":"587","DOI":"10.1128\/CMR.00010-14","article-title":"Antimicrobial resistance in Neisseria gonorrhoeae in the 21st century: past, evolution, and future","volume":"27","author":"Unemo","year":"2014","journal-title":"Clin Microbiol Rev"},{"key":"2024050202520995000_dkae073-B3","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1177\/0956462419886775","article-title":"2018 UK national guideline for the management of infection with Neisseria gonorrhoeae","volume":"31","author":"Fifer","year":"2020","journal-title":"Int J STD AIDS"},{"key":"2024050202520995000_dkae073-B4","author":"UK Health Security Agency"},{"key":"2024050202520995000_dkae073-B5","author":"World Health Organization"},{"issue":"Suppl 4","key":"2024050202520995000_dkae073-B6","doi-asserted-by":"crossref","first-page":"iv47","DOI":"10.1136\/sextrans-2013-051020","article-title":"The role of core groups in the emergence and dissemination of antimicrobial-resistant N. gonorrhoeae","volume":"89","author":"Lewis","year":"2013","journal-title":"Sex Transm Infect"},{"key":"2024050202520995000_dkae073-B7","doi-asserted-by":"crossref","first-page":"329","DOI":"10.3389\/fmed.2018.00329","article-title":"Antimicrobial consumption and susceptibility of Neisseria gonorrhoeae: a global ecological analysis","volume":"5","author":"Kenyon","year":"2018","journal-title":"Front Med (Lausanne)"},{"key":"2024050202520995000_dkae073-B8","author":"UK Health Security Agency"},{"key":"2024050202520995000_dkae073-B9","doi-asserted-by":"publisher","DOI":"10.1128\/microbiolspec.EI10-0009-2015","article-title":"Antimicrobial resistance expressed by Neisseria gonorrhoeae: a major global public health problem in the 21st century","volume":"4","author":"Unemo","year":"2016","journal-title":"Microbiol Spectr"},{"key":"2024050202520995000_dkae073-B10","volume-title":"Tetracycline","author":"Shutter","year":"2021"},{"key":"2024050202520995000_dkae073-B11","first-page":"227","article-title":"Effects of penicillin, streptomycin, and tetracycline on N. gonorrhoeae isolated in 1944 and in 1957","volume":"34","author":"Reyn","year":"1958","journal-title":"Br J Vener Dis"},{"key":"2024050202520995000_dkae073-B12","doi-asserted-by":"crossref","first-page":"664","DOI":"10.1128\/AAC.30.5.664","article-title":"High-level tetracycline resistance in Neisseria gonorrhoeae is result of acquisition of streptococcal tetM determinant","volume":"30","author":"Morse","year":"1986","journal-title":"Antimicrob Agents Chemother"},{"key":"2024050202520995000_dkae073-B13","doi-asserted-by":"crossref","first-page":"2115","DOI":"10.1093\/jac\/dkz130","article-title":"Detection of tet(M) in high-level tetracycline-resistant Neisseria gonorrhoeae","volume":"74","author":"Pitt","year":"2019","journal-title":"J Antimicrob Chemother"},{"key":"2024050202520995000_dkae073-B14","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1097\/00007435-198810000-00008","article-title":"Antibiotic resistance in Neisseria gonorrhoeae: genetics and mechanisms of resistance","volume":"15","author":"Johnson","year":"1988","journal-title":"Sex Transm Dis"},{"key":"2024050202520995000_dkae073-B15","doi-asserted-by":"crossref","first-page":"667","DOI":"10.1093\/jac\/32.5.667","article-title":"Nucleotide sequences of the tet(M) genes from the American and Dutch type tetracycline resistance plasmids of Neisseria gonorrhoeae","volume":"32","author":"Gascoyne-Binzi","year":"1993","journal-title":"J Antimicrob Chemother"},{"key":"2024050202520995000_dkae073-B16","doi-asserted-by":"crossref","first-page":"190","DOI":"10.1177\/0956462419890737","article-title":"Mycoplasma genitalium and antimicrobial resistance in Europe: a comprehensive review","volume":"31","author":"Fern\u00e1ndez-Huerta","year":"2020","journal-title":"Int J STD AIDS"},{"key":"2024050202520995000_dkae073-B17","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1186\/s13756-020-00764-z","article-title":"Gonococcal resistance can be viewed productively as part of a syndemic of antimicrobial resistance: an ecological analysis of 30 European countries","volume":"9","author":"Kenyon","year":"2020","journal-title":"Antimicrob Resist Infect Control"},{"key":"2024050202520995000_dkae073-B18","doi-asserted-by":"crossref","first-page":"540","DOI":"10.1097\/QAI.0000000000001129","article-title":"Preexposure prophylaxis for HIV prevention in a large integrated health care system: adherence, renal safety, and discontinuation","volume":"73","author":"Marcus","year":"2016","journal-title":"J Acquir Immune Defic Syndr"},{"key":"2024050202520995000_dkae073-B19","doi-asserted-by":"crossref","first-page":"1215","DOI":"10.1177\/0956462420957519","article-title":"Screening for STIs in PrEP cohorts results in high levels of antimicrobial consumption","volume":"31","author":"Kenyon","year":"2020","journal-title":"Int J STD AIDS"},{"key":"2024050202520995000_dkae073-B20","doi-asserted-by":"crossref","first-page":"537","DOI":"10.1136\/sextrans-2019-054313","article-title":"Association between STI screening intensity in men who have sex with men and gonococcal susceptibility in 21 states in the USA: an ecological study","volume":"96","author":"Van Dijck","year":"2020","journal-title":"Sex Transm Infect"},{"key":"2024050202520995000_dkae073-B21","doi-asserted-by":"crossref","first-page":"593","DOI":"10.1177\/0956462413482811","article-title":"2013 UK National Guideline for the management of lymphogranuloma venereum: Clinical Effectiveness Group of the British Association for Sexual Health and HIV (CEG\/BASHH) guideline development group","volume":"24","author":"White","year":"2013","journal-title":"Int J STD AIDS"},{"key":"2024050202520995000_dkae073-B22","doi-asserted-by":"crossref","first-page":"938","DOI":"10.1177\/0956462419825948","article-title":"British Association for Sexual Health and HIV national guideline for the management of infection with Mycoplasma genitalium (2018)","volume":"30","author":"Soni","year":"2018","journal-title":"Int J STD AIDS"},{"key":"2024050202520995000_dkae073-B23","author":"BASHH Clinical Effectiveness Group"},{"key":"2024050202520995000_dkae073-B24","doi-asserted-by":"crossref","first-page":"158","DOI":"10.1136\/sextrans-2021-055310","article-title":"Choice of antibiotics for prophylaxis of bacterial STIs among individuals currently self-sourcing","volume":"98","author":"Kohli","year":"2022","journal-title":"Sex Transm Infect"},{"key":"2024050202520995000_dkae073-B25","author":"Public Health England"},{"key":"2024050202520995000_dkae073-B26","author":"UK Health Security Agency"},{"key":"2024050202520995000_dkae073-B27","author":"Public Health England"},{"key":"2024050202520995000_dkae073-B28","author":"Public Health England"},{"key":"2024050202520995000_dkae073-B29","first-page":"1107","article-title":"Population-level antimicrobial consumption is associated with decreased antimicrobial susceptibility in Neisseria gonorrhoeae in 24 European countries: an ecological analysis","volume":"221","author":"Kenyon","year":"2020","journal-title":"J Infect Dis"},{"key":"2024050202520995000_dkae073-B30","doi-asserted-by":"crossref","first-page":"1241","DOI":"10.1093\/jac\/dku525","article-title":"Exploring the association between resistance and outpatient antibiotic use expressed as DDDs or packages","volume":"70","author":"Bruyndonckx","year":"2015","journal-title":"J Antimicrob Chemother"},{"key":"2024050202520995000_dkae073-B31","doi-asserted-by":"crossref","first-page":"176","DOI":"10.1136\/medhum-2019-011780","article-title":"Putting the NHS England on trial: uncertainty-as-power, evidence and the controversy of PrEP in England","volume":"46","author":"Nagington","year":"2020","journal-title":"Med Humanit"},{"key":"2024050202520995000_dkae073-B32","doi-asserted-by":"crossref","first-page":"e397","DOI":"10.1016\/S2352-3018(16)30117-5","article-title":"Time for NHS England to accept responsibility for PrEP","volume":"3","author":"The Lancet HIV","year":"2016","journal-title":"Lancet HIV"},{"key":"2024050202520995000_dkae073-B33","doi-asserted-by":"crossref","first-page":"1195","DOI":"10.3201\/eid2407.172104","article-title":"Effects of sexual network connectivity and antimicrobial drug use on antimicrobial resistance in Neisseria gonorrhoeae","volume":"24","author":"Kenyon","year":"2018","journal-title":"Emerg Infect Dis"},{"key":"2024050202520995000_dkae073-B34","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1097\/QAI.0b013e318247925e","article-title":"A comparison of sexual behavior patterns among men who have sex with men and heterosexual men and women","volume":"60","author":"Glick","year":"2012","journal-title":"J Acquir Immune Defic Syndr"},{"key":"2024050202520995000_dkae073-B35","doi-asserted-by":"crossref","first-page":"2587","DOI":"10.1056\/NEJMoa1011205","article-title":"Preexposure chemoprophylaxis for HIV prevention in men who have sex with men","volume":"363","author":"Grant","year":"2010","journal-title":"N Engl J Med"},{"key":"2024050202520995000_dkae073-B36","author":"NICE"},{"key":"2024050202520995000_dkae073-B37","doi-asserted-by":"crossref","first-page":"3384","DOI":"10.1093\/jac\/dkz321","article-title":"Adaptation of the WHO Essential Medicines List for national antibiotic stewardship policy in England: being AWaRe","volume":"74","author":"Budd","year":"2019","journal-title":"J Antimicrob Chemother"},{"key":"2024050202520995000_dkae073-B38","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1177\/0956462415615443","article-title":"2015 UK national guideline for the management of infection with Chlamydia trachomatis","volume":"27","author":"Nwokolo","year":"2016","journal-title":"Int J STD AIDS"},{"key":"2024050202520995000_dkae073-B39","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1177\/0956462415586675","article-title":"2015 UK national guideline on the management of non-gonococcal urethritis","volume":"27","author":"Horner","year":"2016","journal-title":"Int J STD AIDS"},{"key":"2024050202520995000_dkae073-B40","doi-asserted-by":"crossref","first-page":"421","DOI":"10.1177\/0956462415624059","article-title":"UK national guidelines on the management of syphilis 2015","volume":"27","author":"Kingston","year":"2016","journal-title":"Int J STD AIDS"},{"key":"2024050202520995000_dkae073-B41","author":"Ross"},{"key":"2024050202520995000_dkae073-B42","doi-asserted-by":"crossref","first-page":"429","DOI":"10.1136\/sextrans-2020-054592","article-title":"Factors associated with reporting antibiotic use as STI prophylaxis among HIV PrEP users: findings from a cross-sectional online community survey, May-July 2019, UK","volume":"97","author":"O\u2019Halloran","year":"2021","journal-title":"Sex Transm Infect"},{"key":"2024050202520995000_dkae073-B43","doi-asserted-by":"crossref","first-page":"e482","DOI":"10.1016\/S2352-3018(18)30210-8","article-title":"Doxycycline use in MSM taking PrEP","volume":"5","author":"Carveth-Johnson","year":"2018","journal-title":"Lancet HIV"},{"key":"2024050202520995000_dkae073-B44","doi-asserted-by":"crossref","first-page":"1296","DOI":"10.1056\/NEJMoa2211934","article-title":"Postexposure doxycycline to prevent bacterial sexually transmitted infections","volume":"388","author":"Luetkemeyer","year":"2023","journal-title":"N Engl J Med"},{"key":"2024050202520995000_dkae073-B45","author":"Centers for Disease Control and Prevention"},{"key":"2024050202520995000_dkae073-B46","doi-asserted-by":"crossref","first-page":"E11988","DOI":"10.1073\/pnas.1810840115","article-title":"Estimating the proportion of bystander selection for antibiotic resistance among potentially pathogenic bacterial flora","volume":"115","author":"Tedijanto","year":"2018","journal-title":"Proc Natl Acad Sci U S A"},{"key":"2024050202520995000_dkae073-B47","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1136\/sextrans-2021-055298","article-title":"Is there an association between previous infection with Neisseria gonorrhoeae and gonococcal AMR? A cross-sectional analysis of national and sentinel surveillance data in England, 2015\u20132019","volume":"99","author":"Allen","year":"2023","journal-title":"Sex Transm Infect"},{"key":"2024050202520995000_dkae073-B48","first-page":"A35-A","article-title":"O09.2 Lack of association between azithromycin-resistant Neisseria gonorrhoeae infection and prior exposure to azithromycin among persons attending a Sexual Health Clinic","volume":"97","author":"Rowlinson","year":"2021","journal-title":"Sex Transm Infect"},{"key":"2024050202520995000_dkae073-B49","doi-asserted-by":"crossref","first-page":"421","DOI":"10.1136\/sextrans-2017-053461","article-title":"Is previous azithromycin treatment associated with azithromycin resistance in Neisseria gonorrhoeae? A cross-sectional study using national surveillance data in England","volume":"94","author":"Clifton","year":"2018","journal-title":"Sex Transm Infect"}],"container-title":["Journal of Antimicrobial Chemotherapy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/jac\/article-pdf\/79\/5\/1060\/57368314\/dkae073.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jac\/article-pdf\/79\/5\/1060\/57368314\/dkae073.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,2]],"date-time":"2024-05-02T02:54:13Z","timestamp":1714618453000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jac\/article\/79\/5\/1060\/7633593"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,3,22]]},"references-count":49,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2024,3,22]]},"published-print":{"date-parts":[[2024,5,2]]}},"URL":"https:\/\/doi.org\/10.1093\/jac\/dkae073","relation":{},"ISSN":["0305-7453","1460-2091"],"issn-type":[{"value":"0305-7453","type":"print"},{"value":"1460-2091","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2024,5]]},"published":{"date-parts":[[2024,3,22]]}}}