{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T12:26:06Z","timestamp":1786969566095,"version":"build-2736575974"},"reference-count":10,"publisher":"BMJ","issue":"1","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Sex Transm Infect"],"accepted":{"date-parts":[[2025,2,19]]},"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>\n                      Increasing ceftriaxone-resistant\n                      <jats:italic>Neisseria gonorrhoeae<\/jats:italic>\n                      is of public health concern. A cluster of ceftriaxone-resistant\n                      <jats:italic>N. gonorrhoeae<\/jats:italic>\n                      was identified in 2022, which was linked to heterosexuals from the Asia-Pacific region who were studying at UK universities. The possibility of further transmission within and beyond this network was of concern, particularly as not all gonococcal cases have a positive culture for antimicrobial susceptibility testing to be performed. We, therefore, undertook a case finding exercise using an\n                      <jats:italic>N. gonorrhoeae penA<\/jats:italic>\n                      real-time PCR to identify undetected transmission of ceftriaxone-resistant strains. The PCR detects\n                      <jats:italic>penA<\/jats:italic>\n                      -60.001, which is the most common gonococcal ceftriaxone-resistance mechanism. The aim of this Gonorrhoea Undetected Resistance Laboratory Study was to estimate the prevalence of undetected ceftriaxone-resistant\n                      <jats:italic>N. gonorrhoeae<\/jats:italic>\n                      in England.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Sexually transmitted infection surveillance data (2017\u20132021) was combined with university data on student country of origin to identify sexual health services in English university towns with the highest number of gonorrhoea cases among those of Asian ethnicity born in selected countries of the Asia-Pacific region. Residual\n                      <jats:italic>N. gonorrhoeae<\/jats:italic>\n                      -positive molecular specimens from women (as a proxy for heterosexual behaviour) aged 18\u201330 years were sent to the UK Health Security Agency (UKHSA) for testing.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Between February 2023 and March 2024, 921 specimens meeting the inclusion criteria were received, of which 661 were reconfirmed as\n                      <jats:italic>N. gonorrhoeae<\/jats:italic>\n                      . Of these, one was positive on the\n                      <jats:italic>penA<\/jats:italic>\n                      PCR, indicating ceftriaxone resistance; this specimen came from a previously identified case, therefore no \u2018undetected\u2019 cases were identified.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>\n                      This case-finding exercise provided reassurance that ceftriaxone-resistant\n                      <jats:italic>N. gonorrhoeae<\/jats:italic>\n                      in England is currently adequately detected through the existing UKHSA-enhanced surveillance activities. The current\n                      <jats:italic>penA<\/jats:italic>\n                      PCR is a useful tool in the fight to keep gonorrhoea a treatable infection; however, it requires expansion as it does not currently detect all\n                      <jats:italic>penA<\/jats:italic>\n                      alleles responsible for ceftriaxone resistance.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/sextrans-2024-056459","type":"journal-article","created":{"date-parts":[[2025,3,5]],"date-time":"2025-03-05T13:21:01Z","timestamp":1741180861000},"page":"32-35","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["What are we missing? Data from the Gonorrhoea Undetected Resistance Laboratory Study (GURLS)"],"prefix":"10.1136","volume":"102","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6707-6910","authenticated-orcid":false,"given":"Michelle Jayne","family":"Cole","sequence":"first","affiliation":[{"name":"UK Health Security Agency, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Vickers","sequence":"additional","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\/0000-0002-5089-2321","authenticated-orcid":false,"given":"Michaela Joanne","family":"Day","sequence":"additional","affiliation":[{"name":"UK Health Security Agency, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ross","family":"Harris","sequence":"additional","affiliation":[{"name":"UK Health Security Agency, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Burgess Tornaletti","sequence":"additional","affiliation":[{"name":"The University of Manchester Faculty of Biology Medicine and Health, Manchester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katie","family":"Thorley","sequence":"additional","affiliation":[{"name":"UK Health Security Agency, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hussain","family":"Ahmed","sequence":"additional","affiliation":[{"name":"University Hospitals Birmingham NHS Foundation Trust, Birmingham, England, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monica","family":"Rebec","sequence":"additional","affiliation":[{"name":"Infection and Immunity Laboratory, NHS North West London Pathology, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miriam","family":"O\u2019Connor","sequence":"additional","affiliation":[{"name":"Chelsea and Westminster Hospital NHS Foundation Trust, London, England, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Soma","family":"N\u2019Jai-Ndimbalan","sequence":"additional","affiliation":[{"name":"Guy's and St Thomas\u2019 NHS Foundation Trust, London, England, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alan","family":"Lord","sequence":"additional","affiliation":[{"name":"Manchester University NHS Foundation Trust, Manchester, England, UK"},{"name":"UK Health Security Agency, Manchester, England, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4744-8542","authenticated-orcid":false,"given":"Mark","family":"Hopkins","sequence":"additional","affiliation":[{"name":"Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Grant","sequence":"additional","affiliation":[{"name":"Health Service Laboratories, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Muir","sequence":"additional","affiliation":[{"name":"Infection Sciences, North Bristol NHS Trust, Bristol, UK"},{"name":"South West Regional Laboratory, UKHSA, Bristol, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kate","family":"Sibson","sequence":"additional","affiliation":[{"name":"Leeds Teaching Hospitals NHS Trust, Leeds, England, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2060-7286","authenticated-orcid":false,"given":"Hamish","family":"Mohammed","sequence":"additional","affiliation":[{"name":"UK Health Security Agency, London, UK"},{"name":"The National Institute for Health Research Health Protection Research Unit in Blood Borne and Sexually Transmitted Infections at University College London in Partnership with the 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\/0000-0002-3524-5935","authenticated-orcid":false,"given":"Rachel","family":"Pitt-Kendall","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":"239","published-online":{"date-parts":[[2025,3,5]]},"reference":[{"key":"2026081704400943000_102.1.32.1","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dkae369"},{"key":"2026081704400943000_102.1.32.2","doi-asserted-by":"publisher","DOI":"10.1177\/0956462419886775"},{"key":"2026081704400943000_102.1.32.3","doi-asserted-by":"publisher","DOI":"10.1136\/sextrans-2014-051756"},{"key":"2026081704400943000_102.1.32.4","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1016\/j.jgar.2019.02.011","article-title":"A real-time PCR assay for detecting a penA mutation associated with ceftriaxone resistance in Neisseria gonorrhoeae","volume":"19","author":"Shimuta","year":"2019","journal-title":"J Glob Antimicrob Resist"},{"key":"2026081704400943000_102.1.32.5","doi-asserted-by":"publisher","DOI":"10.1136\/sextrans-2024-056132"},{"key":"2026081704400943000_102.1.32.6","doi-asserted-by":"crossref","unstructured":"Day M , Pitt R , Mody N , et al . Detection of 10 cases of ceftriaxone-resistant Neisseria gonorrhoeae in the United Kingdom, December 2021 to June 2022. Euro Surveill 2022;27. doi:10.2807\/1560-7917.ES.2022.27.46.2200803","DOI":"10.2807\/1560-7917.ES.2022.27.46.2200803"},{"key":"2026081704400943000_102.1.32.7","unstructured":"Migchelsen SJ , Edney J , O\u2019Brien N , et al . Sexually transmitted infections and screening for chlamydia in England, 2023. 2024. Available: https:\/\/www.gov.uk\/government\/statistics\/sexually-transmitted-infections-stis-annual-data-tables\/sexually-transmitted-infections-and-screening-for-chlamydia-in-england-2023-report [Accessed 23 Jan 2025]."},{"key":"2026081704400943000_102.1.32.8","unstructured":"European committee on antimicrobial susceptibility testing . Breakpoint tables for interpretation of mics and zone diameters. 2024. Available: https:\/\/www.eucast.org\/fileadmin\/src\/media\/PDFs\/EUCAST_files\/Breakpoint_tables\/v_14.0_Breakpoint_Tables.pdf [Accessed 23 Jan 2025]."},{"key":"2026081704400943000_102.1.32.9","unstructured":"Sun S , Narayanan P , Vickers A , et al . GRASP report: data to August 2024. 2024. Available: https:\/\/www.gov.uk\/government\/publications\/gonococcal-resistance-to-antimicrobials-surveillance-programme-grasp-report\/grasp-report-data-to-august-2024 [Accessed 23 Jan 2025]."},{"key":"2026081704400943000_102.1.32.10","article-title":"The WHO Enhanced Gonococcal Antimicrobial Surveillance Programme (EGASP) identifies high levels of ceftriaxone resistance across Vietnam, 2023","volume":"48","author":"Lan","year":"2024","journal-title":"Lancet Reg Health West Pac"}],"container-title":["Sexually Transmitted Infections"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/sextrans-2024-056459","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T11:40:32Z","timestamp":1786966832000},"score":1,"resource":{"primary":{"URL":"https:\/\/sti.bmj.com\/lookup\/doi\/10.1136\/sextrans-2024-056459"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3,5]]},"references-count":10,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,1,16]]},"published-print":{"date-parts":[[2026,2]]}},"alternative-id":["10.1136\/sextrans-2024-056459"],"URL":"https:\/\/doi.org\/10.1136\/sextrans-2024-056459","relation":{},"ISSN":["1368-4973","1472-3263"],"issn-type":[{"value":"1368-4973","type":"print"},{"value":"1472-3263","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,3,5]]}}}