{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T07:23:10Z","timestamp":1778656990014,"version":"3.51.4"},"reference-count":27,"publisher":"BMJ","issue":"1","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Sex Transm Infect"],"published-print":{"date-parts":[[2023,2]]},"abstract":"<jats:sec><jats:title>Objectives<\/jats:title><jats:p>Quarterly STI screening is recommended for high-risk gay, bisexual and other men who have sex with men (MSM) in the UK, but frequent antibiotic exposure could potentially increase the risk of antimicrobial resistance (AMR) developing in<jats:italic>Neisseria gonorrhoeae<\/jats:italic>. We investigated whether repeat diagnosis of gonorrhoea in those attending sexual health services (SHS) was associated with reduced antimicrobial susceptibility.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Antimicrobial susceptibility data relating to the most recent gonorrhoea diagnosis for each individual included in the Gonococcal Resistance to Antimicrobials Surveillance Programme (2015\u20132019) were matched to their historical records in the national GUMCAD STI surveillance data set (2012\u20132019). The number of gonorrhoea diagnoses in the previous 3\u2009years was calculated for each SHS attendee. Logistic regression was used to examine the associations between the number of diagnoses and reduced susceptibility to ceftriaxone (minimum inhibitory concentration (MIC) &gt;0.03\u2009mg\/L), cefixime (MIC &gt;0.06\u2009mg\/L) and azithromycin (MIC &gt;0.25\u2009mg\/L) at the time of the latest diagnosis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of 6161 individuals included in the analysis, 3913 (63.5%) were MSM, 1220 (19.8%) were heterosexual men and 814 (13.2%) were women. Among MSM, 2476 (63.3%) had 1 past gonorrhoea diagnosis, 1295 (33.1%) had 2\u20134, 140 (3.6%) 5\u20139, and 2 (0.1%) \u226510. Most women and heterosexual men (91.7%) had one past gonorrhoea diagnosis; none had more than four. Reduced ceftriaxone and cefixime susceptibility was more common among MSM with two to four gonorrhoea diagnoses (3.8% and 5.8%, respectively) compared with those with one (2.2% and 3.9%, respectively). After adjusting for potential confounding, this association remained (adjusted OR: 1.59, 95%\u2009CI 1.07 to 2.37, p=0.02; adjusted OR: 1.54, 95%\u2009CI 1.11 to 2.14, p=0.01). No evidence was found for any other associations.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Among MSM, repeat diagnosis of gonorrhoea may be associated with reduced ceftriaxone and cefixime susceptibility. As these are last-line therapies for gonorrhoea, further research is needed to assess the impact of intensive STI screening on AMR.<\/jats:p><\/jats:sec>","DOI":"10.1136\/sextrans-2021-055298","type":"journal-article","created":{"date-parts":[[2022,3,4]],"date-time":"2022-03-04T18:25:35Z","timestamp":1646418335000},"page":"1-6","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":13,"title":["Is there an association between previous infection with<i>Neisseria gonorrhoeae<\/i>and gonococcal AMR? A cross-sectional analysis of national and sentinel surveillance data in England, 2015\u20132019"],"prefix":"10.1136","volume":"99","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7213-5471","authenticated-orcid":false,"given":"Hester","family":"Allen","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rachel","family":"Merrick","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zdravko","family":"Ivanov","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3524-5935","authenticated-orcid":false,"given":"Rachel","family":"Pitt","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2060-7286","authenticated-orcid":false,"given":"Hamish","family":"Mohammed","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katy","family":"Sinka","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2090-7702","authenticated-orcid":false,"given":"Gwenda","family":"Hughes","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7756-403X","authenticated-orcid":false,"given":"Helen","family":"Fifer","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6707-6910","authenticated-orcid":false,"given":"Michelle Jayne","family":"Cole","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2022,3,4]]},"reference":[{"key":"2023101000001310000_99.1.1.1","unstructured":"Merrick R AH , Ivanov Z , Pitt R . Antimicrobial resistance in Neisseria gonorrhoeae in England and Wales. Key findings from the gonococcal resistance to antimicrobials surveillance programme (GRASP 2019). Public Health England, 2020."},{"key":"2023101000001310000_99.1.1.2","doi-asserted-by":"publisher","DOI":"10.2471\/BLT.18.228486"},{"key":"2023101000001310000_99.1.1.3","doi-asserted-by":"crossref","first-page":"412","DOI":"10.1071\/SH19023","article-title":"World Health organization global gonococcal antimicrobial surveillance program (who GASP): review of new data and evidence to inform international collaborative actions and research efforts","volume":"16","author":"Unemo","year":"2019","journal-title":"Sex Health"},{"key":"2023101000001310000_99.1.1.4","unstructured":"Mitchell H et al . Sexually transmitted infections and screening for Chlamydia in England, 2019. Public Health England London, 2020."},{"key":"2023101000001310000_99.1.1.5","doi-asserted-by":"publisher","DOI":"10.1177\/0956462419886775"},{"key":"2023101000001310000_99.1.1.6","doi-asserted-by":"crossref","DOI":"10.2807\/1560-7917.ES.2018.23.27.1800323","article-title":"Gonorrhoea treatment failure caused by a Neisseria gonorrhoeae strain with combined ceftriaxone and high-level azithromycin resistance, England, February 2018","volume":"23","author":"Eyre","year":"2018","journal-title":"Euro Surveill"},{"key":"2023101000001310000_99.1.1.7","doi-asserted-by":"crossref","DOI":"10.2807\/1560-7917.ES.2019.24.8.1900118","article-title":"Genetic relatedness of ceftriaxone-resistant and high-level azithromycin resistant Neisseria gonorrhoeae cases, United Kingdom and Australia, February to April 2018","volume":"24","author":"Jennison","year":"2019","journal-title":"Euro Surveill"},{"key":"2023101000001310000_99.1.1.8","doi-asserted-by":"crossref","DOI":"10.2807\/1560-7917.ES.2019.24.10.1900147","article-title":"Detection in the United Kingdom of the Neisseria gonorrhoeae FC428 clone, with ceftriaxone resistance and intermediate resistance to azithromycin, October to December 2018","volume":"24","author":"Eyre","year":"2019","journal-title":"Euro Surveill"},{"key":"2023101000001310000_99.1.1.9","doi-asserted-by":"publisher","DOI":"10.3201\/eid2407.172104"},{"key":"2023101000001310000_99.1.1.10","doi-asserted-by":"crossref","DOI":"10.12688\/f1000research.14869.2","article-title":"Does gonorrhoea screening intensity play a role in the early selection of antimicrobial resistance in men who have sex with men (MSM)? A comparative study of Belgium and the United Kingdom","volume":"7","author":"Kenyon","year":"2018","journal-title":"F1000Res"},{"key":"2023101000001310000_99.1.1.11","unstructured":"British HIV Association, . Recommendations for testing for sexually transmitted infections in men who have sex with men. British HIV Association, 2014."},{"key":"2023101000001310000_99.1.1.12","first-page":"1","article-title":"2016 United Kingdom national guideline on the sexual health care of men who have sex with men","volume":"15","author":"Clutterbuck","year":"2018","journal-title":"Int J STD AIDS"},{"key":"2023101000001310000_99.1.1.13","doi-asserted-by":"publisher","DOI":"10.1136\/sextrans-2017-053461"},{"key":"2023101000001310000_99.1.1.14","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.00309-10"},{"key":"2023101000001310000_99.1.1.15","doi-asserted-by":"crossref","first-page":"619","DOI":"10.1093\/infdis\/jiy551","article-title":"Azithromycin susceptibility among Neisseria gonorrhoeae isolates and seasonal macrolide use","volume":"219","author":"Olesen","year":"2019","journal-title":"J Infect Dis"},{"key":"2023101000001310000_99.1.1.16","doi-asserted-by":"crossref","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":"2023101000001310000_99.1.1.17","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.46.9.3020-3025.2002"},{"key":"2023101000001310000_99.1.1.18","unstructured":"Public Health England . 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GUMCAD STI surveillance system: data specification and technical guidance, 2020."},{"key":"2023101000001310000_99.1.1.21","doi-asserted-by":"crossref","DOI":"10.1186\/s12879-021-05931-0","article-title":"Associations between antimicrobial susceptibility\/resistance of Neisseria gonorrhoeae isolates in European Union\/European economic area and patients' gender, sexual orientation and anatomical site of infection, 2009-2016","volume":"21","author":"Jacobsson","year":"2021","journal-title":"BMC Infect Dis"},{"key":"2023101000001310000_99.1.1.22","doi-asserted-by":"crossref","unstructured":"Rowlinson E SO , Berzkalns A , Thibault C . O09.2 lack of association between Azithromycin-Resistant Neisseria gonorrhoeae infection and prior exposure to azithromycin among persons attendig a sexual health clinic. 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