{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,26]],"date-time":"2025-10-26T22:53:37Z","timestamp":1761519217421,"version":"3.37.3"},"reference-count":28,"publisher":"BMJ","issue":"6","funder":[{"DOI":"10.13039\/501100000659","name":"Research Trainees Coordinating Centre","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000659","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Sex Transm Infect"],"published-print":{"date-parts":[[2018,9]]},"abstract":"<jats:sec><jats:title>Objectives<\/jats:title><jats:p>It has been suggested that treatment of STIs with azithromycin may facilitate development of azithromycin resistance in <jats:italic>Neisseria gonorrhoeae<\/jats:italic> (NG) by exposing the organism to suboptimal doses. We investigated whether treatment history for non-rectal <jats:italic>Chlamydia trachomatis<\/jats:italic> (CT), non-gonococcal urethritis (NGU) or NG (proxies for azithromycin exposure) in sexual health (GUM) services was associated with susceptibility of NG to azithromycin.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Azithromycin susceptibility data from the Gonococcal Resistance to Antimicrobials Surveillance Programme (GRASP 2013\u20132015, n=4606) and additional high-level azithromycin-resistant isolates (HL-AziR) identified by the Public Health England reference laboratory (2013\u20132016, n=54) were matched to electronic patient records in the national GUMCAD STI surveillance dataset (2012\u20132016). Descriptive and regression analyses were conducted to examine associations between history of previous CT\/NGU\/NG and subsequent susceptibility of NG to azithromycin.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Modal azithromycin minimum inhibitory concentration (MIC) was 0.25\u2009mg\/L (one dilution below the resistance breakpoint) in those with and without history of previous CT\/NGU\/NG (previous 1\u2009month\/6 months). There were no differences in MIC distribution by history of CT\/NGU (P=0.98) or NG (P=0.85) in the previous 1\u2009month\/6 months or in the odds of having an elevated azithromycin MIC (&gt;0.25\u2009mg\/L) (Adjusted OR for CT\/NGU 0.97 (95% CI 0.76 to 1.25); adjusted OR for NG 0.82 (95% CI: 0.65 to 1.04)) compared with those with no CT\/NGU\/NG in the previous 6 months. Among patients with HL-AziR NG, 3 (4%) were treated for CT\/NGU and 2 (3%) for NG in the previous 6 months, compared with 6% and 8%, respectively for all GRASP patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>We found no evidence of an association between previous treatment for CT\/NGU or NG in GUM services and subsequent presentation with an azithromycin-resistant strain. As many CT diagnoses occur in non-GUM settings, further research is needed to determine whether azithromycin-resistant NG is associated with azithromycin exposure in other settings and for other conditions.<\/jats:p><\/jats:sec>","DOI":"10.1136\/sextrans-2017-053461","type":"journal-article","created":{"date-parts":[[2018,3,6]],"date-time":"2018-03-06T17:15:24Z","timestamp":1520356524000},"page":"421-426","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":19,"title":["Is previous azithromycin treatment associated with azithromycin resistance in <i>Neisseria gonorrhoeae<\/i>? A cross-sectional study using national surveillance data in England"],"prefix":"10.1136","volume":"94","author":[{"given":"Soazig","family":"Clifton","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katy","family":"Town","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Martina","family":"Furegato","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michelle","family":"Cole","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hamish","family":"Mohammed","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sarah C","family":"Woodhall","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J","family":"Kevin Dunbar","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Helen","family":"Fifer","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gwenda","family":"Hughes","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2018,3,6]]},"reference":[{"key":"2020050723333953000_94.6.421.1","doi-asserted-by":"publisher","DOI":"10.1258\/ijsa.2011.011267"},{"key":"2020050723333953000_94.6.421.2","unstructured":"Public Health England. Surveillance of antimicrobial resistance in Neisseria gonorrhoeae Key findings from the Gonococcal Resistance to Antimicrobials Surveillance Programme (GRASP) - data up to October 2016. London, 2017."},{"key":"2020050723333953000_94.6.421.3","first-page":"365","article-title":"An outbreak of high-level azithromycin resistant Neisseria gonorrhoeae in England","volume":"388","author":"Chisholm","year":"2015","journal-title":"Sex Transm Infect"},{"key":"2020050723333953000_94.6.421.4","doi-asserted-by":"publisher","DOI":"10.1136\/sextrans-2015-052312"},{"key":"2020050723333953000_94.6.421.5","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(17)30310-9"},{"key":"2020050723333953000_94.6.421.6","doi-asserted-by":"publisher","DOI":"10.1136\/sextrans-2016-052583"},{"key":"2020050723333953000_94.6.421.7","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMc1512757"},{"key":"2020050723333953000_94.6.421.8","doi-asserted-by":"crossref","unstructured":"Alirol E , Wi TE , Bala M , et al . Multidrug-resistant gonorrhea: a research and development roadmap to discover new medicines. PLoS Med 2017;14:e1002366.doi:10.1371\/journal.pmed.1002366","DOI":"10.1371\/journal.pmed.1002366"},{"key":"2020050723333953000_94.6.421.9","unstructured":"Azithromycin uses, dosage and side effects. https:\/\/www.drugs.com\/monograph\/azithromycin.html (accessed 4 Aug 2017)."},{"key":"2020050723333953000_94.6.421.10","doi-asserted-by":"publisher","DOI":"10.2217\/fmb.14.110"},{"key":"2020050723333953000_94.6.421.11","doi-asserted-by":"crossref","unstructured":"Wind CM , de Vries E , Schim van der Loeff MF , et al . Decreased azithromycin susceptibility of Neisseria gonorrhoeae isolates in patients recently treated with azithromycin. 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