{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T20:00:47Z","timestamp":1784836847186,"version":"3.55.0"},"reference-count":49,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,6,29]],"date-time":"2023-06-29T00:00:00Z","timestamp":1687996800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Microbiol."],"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>Gonorrhoea is a major public health concern. With the global emergence and spread of resistance to last-line antibiotic treatment options, gonorrhoea threatens to be untreatable in the future. Therefore, this study performed whole genome characterization of <jats:italic>Neisseria gonorrhoeae<\/jats:italic> collected in Ghana to identify lineages of circulating strains as well as their phenotypic and genotypic antimicrobial resistance (AMR) profiles.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Whole genome sequencing (WGS) was performed on 56 isolates using both the Oxford Nanopore MinION and Illumina MiSeq sequencing platforms. The Comprehensive Antimicrobial Resistance Database (CARD) and <jats:ext-link>PUBMLST.org\/neisseria<\/jats:ext-link> databases were used to catalogue chromosomal and plasmid genes implicated in AMR. The core genome multi-locus sequence typing (cgMLST) approach was used for comparative genomics analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results and Discussion<\/jats:title><jats:p><jats:italic>In vitro<\/jats:italic> resistance measured by the E-test method revealed 100%, 91.0% and 85.7% resistance to tetracycline, penicillin and ciprofloxacin, respectively. A total of 22 sequence types (STs) were identified by multilocus sequence typing (MLST), with ST-14422 (<jats:italic>n<\/jats:italic> = 10), ST-1927 (<jats:italic>n<\/jats:italic> = 8) and ST-11210 (<jats:italic>n<\/jats:italic> = 7) being the most prevalent. Six novel STs were also identified (ST-15634, 15636-15639 and 15641). All isolates harboured chromosomal AMR determinants that confer resistance to beta-lactam antimicrobials and tetracycline. A single cefixime-resistant strain, that belongs to <jats:italic>N. gonorrhoeae<\/jats:italic> multiantigen sequence type (NG-MAST) ST1407, a type associated with widespread cephalosporin resistance was identified. <jats:italic>Neisseria gonorrhoeae<\/jats:italic> Sequence Typing for Antimicrobial Resistance (NG-STAR), identified 29 unique sequence types, with ST-464 (<jats:italic>n<\/jats:italic> = 8) and the novel ST-3366 (<jats:italic>n<\/jats:italic> = 8) being the most prevalent. Notably, 20 of the 29 STs were novel, indicative of the unique nature of molecular AMR determinants in the Ghanaian strains. Plasmids were highly prevalent: pTetM and p<jats:italic>bla<\/jats:italic>TEM were found in 96% and 92% of isolates, respectively. The TEM-135 allele, which is an amino acid change away from producing a stable extended-spectrum \u03b2-lactamase that could result in complete cephalosporin resistance, was identified in 28.5% of the isolates. Using WGS, we characterized <jats:italic>N. gonorrhoeae<\/jats:italic> strains from Ghana, giving a snapshot of the current state of gonococcal AMR in the country and highlighting the need for constant genomic surveillance.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fmicb.2023.1163450","type":"journal-article","created":{"date-parts":[[2023,6,29]],"date-time":"2023-06-29T09:36:17Z","timestamp":1688031377000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":8,"title":["Whole genome analysis and antimicrobial resistance of Neisseria gonorrhoeae isolates from Ghana"],"prefix":"10.3389","volume":"14","author":[{"given":"Bright","family":"Agbodzi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samuel","family":"Duodu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helena","family":"Dela","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Selassie","family":"Kumordjie","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clara","family":"Yeboah","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric","family":"Behene","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen","family":"Ocansey","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer N.","family":"Yanney","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George","family":"Boateng-Sarfo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samuel Kojo","family":"Kwofie","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beverly","family":"Egyir","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sophie M.","family":"Colston","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hugo V.","family":"Miranda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chaselynn","family":"Watters","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Terrel","family":"Sanders","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne T.","family":"Fox","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew G.","family":"Letizia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael R.","family":"Wiley","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naiki","family":"Attram","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2023,6,29]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"1214","DOI":"10.1016\/S1473-3099(16)30223-7","article-title":"Whole-genome sequencing\u2014new tools for gonorrhoea control","volume":"16","author":"Allen","year":"2016","journal-title":"Lancet Infect. Dis."},{"key":"ref2","doi-asserted-by":"publisher","first-page":"e0223598","DOI":"10.1371\/journal.pone.0223598","article-title":"Antimicrobial resistance (AMR) and molecular characterization of Neisseria gonorrhoeae in Ghana, 2012-2015","volume":"14","author":"Attram","year":"2019","journal-title":"PLoS One"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"e1007930","DOI":"10.1371\/JOURNAL.PCBI.1007930","article-title":"Phenotypic delay in the evolution of bacterial antibiotic resistance: mechanistic models and their implications","volume":"16","author":"Carballo-Pacheco","year":"2020","journal-title":"PLoS Comput. Biol."},{"key":"ref4","doi-asserted-by":"publisher","first-page":"801","DOI":"10.1093\/infdis\/jiy240","article-title":"Identifcation of novel Neisseria gonorrhoeae lineages harboring resistance plasmids in coastal Kenya","volume":"218","author":"Cehovin","year":"2018","journal-title":"J. Infect. Dis."},{"key":"ref5","doi-asserted-by":"publisher","first-page":"p.ftx071","DOI":"10.1093\/femspd\/ftx071","article-title":"Mobile genetic elements in Neisseria gonorrhoeae: movement for change","volume":"75","author":"Cehovin","year":"2017","journal-title":"Pathog. Dis."},{"key":"ref6","doi-asserted-by":"publisher","first-page":"617","DOI":"10.1016\/j.bjm.2017.06.001","article-title":"Antimicrobial resistance in Neisseria gonorrhoeae: history, molecular mechanisms and epidemiological aspects of an emerging global threat","volume":"48","author":"da Costa-Louren\u00e7o","year":"2017","journal-title":"Braz. J. Microbiol."},{"key":"ref7","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12879-019-4035-y","article-title":"Risk factors associated with gonorrhea and chlamydia transmission in selected health facilities in Ghana","volume":"19","author":"dela","year":"2019","journal-title":"BMC Infect. 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Agents Chemother."},{"key":"ref29","doi-asserted-by":"publisher","first-page":"A29.1","DOI":"10.1136\/sextrans-2017-053264.72","article-title":"O13.1 survey of antimicrobial resistance in clinical Neisseria gonorrhoeae isolated over four years in Nairobi \u2013 Kenya","volume":"93","author":"Omolo","year":"2017","journal-title":"Sex. Transm. Infect."},{"key":"ref30","doi-asserted-by":"publisher","first-page":"207","DOI":"10.1016\/J.CMI.2019.08.004","article-title":"Gentamicin 240 mg plus azithromycin 2 g vs. ceftriaxone 500 mg plus azithromycin 2 g for treatment of rectal and pharyngeal gonorrhoea: a randomized controlled trial","volume":"26","author":"Rob","year":"2020","journal-title":"Clin. Microbiol. Infect."},{"key":"ref31","doi-asserted-by":"publisher","first-page":"548","DOI":"10.2471\/BLT.18.228486","article-title":"Chlamydia, gonorrhoea, trichomoniasis and syphilis: global prevalence and incidence estimates, 2016","volume":"97","author":"Rowley","year":"2019","journal-title":"Bull. World Health Organ."},{"key":"ref32","doi-asserted-by":"publisher","first-page":"1941","DOI":"10.1038\/s41564-019-0501-y","article-title":"The impact of antimicrobials on gonococcal evolution","volume":"4","author":"S\u00e1nchez-Bus\u00f3","year":"2019","journal-title":"Nat. Microbiol."},{"key":"ref33","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12879-015-1110-x","article-title":"Emergence and evolution of internationally disseminated cephalosporin-resistant Neisseria gonorrhoeae clones from 1995 to 2005 in Japan","volume":"15","author":"Shimuta","year":"2015","journal-title":"BMC Infect. Dis."},{"key":"ref34","volume-title":"Antimicrobial resistance in","author":"Tapsall","year":"2001"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"619","DOI":"10.1586\/14787210.4.4.619","article-title":"Antibiotic resistance in Neisseria gonorrhoeae is diminishing available treatment options for gonorrhea: some possible remedies","volume":"4","author":"Tapsall","year":"2006","journal-title":"Expert Rev. Anti-Infect. Ther."},{"key":"ref36","doi-asserted-by":"publisher","first-page":"157","DOI":"10.1097\/OLQ.0000000000000587","article-title":"Resistance to ceftriaxone and azithromycin in Neisseria gonorrhoeae isolates from 7 countries of South America and the Caribbean: 2010-2011","volume":"44","author":"Thakur","year":"2017","journal-title":"Sex. Transm. Dis."},{"key":"ref37","doi-asserted-by":"publisher","first-page":"1510","DOI":"10.1093\/jac\/dkt543","article-title":"Unique combined penA\/mtrR\/porB mutations and NG-MAST strain types associated with ceftriaxone and cefixime MIC increases in a \u201csusceptible\u201d Neisseria gonorrhoeae population","volume":"69","author":"Thakur","year":"2014","journal-title":"J. Antimicrob. Chemother."},{"key":"ref38","doi-asserted-by":"publisher","first-page":"364","DOI":"10.1186\/s12879-015-1029-2","article-title":"Current and future antimicrobial treatment of gonorrhoea - the rapidly evolving Neisseria gonorrhoeae continues to challenge","volume":"15","author":"Unemo","year":"2015","journal-title":"BMC Infect. Dis."},{"key":"ref39","doi-asserted-by":"publisher","first-page":"1273","DOI":"10.1128\/AAC.05760-11","article-title":"High-level cefixime- and ceftriaxone-resistant Neisseria gonorrhoeae in France: novel penA mosaic allele in a successful international clone causes treatment failure","volume":"56","author":"Unemo","year":"2012","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref40","doi-asserted-by":"publisher","first-page":"3096","DOI":"10.1093\/jac\/dkw288","article-title":"The novel 2016 WHO Neisseria gonorrhoeae reference strains for global quality assurance of laboratory investigations: phenotypic, genetic and reference genome characterization","volume":"71","author":"Unemo","year":"2016","journal-title":"J. Antimicrob. Chemother."},{"key":"ref41","doi-asserted-by":"publisher","first-page":"653","DOI":"10.1586\/14787210.2014.906902","article-title":"Challenges with gonorrhea in the era of multi-drug and extensively drug resistance-are we on the right track?","volume":"12","author":"Unemo","year":"2014","journal-title":"Expert Rev. Anti-Infect. Ther."},{"key":"ref42","doi-asserted-by":"publisher","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":"ref43","doi-asserted-by":"publisher","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":"ref44","doi-asserted-by":"publisher","first-page":"486","DOI":"10.1016\/S1473-3099(18)30162-2","article-title":"Dual antimicrobial therapy for gonorrhoea: what is the role of azithromycin?","volume":"18","author":"Unemo","year":"2018","journal-title":"Lancet Infect. Dis."},{"key":"ref45","doi-asserted-by":"publisher","first-page":"3111","DOI":"10.1128\/AAC.00306-07","article-title":"Diversity of penA alterations and subtypes in Neisseria gonorrhoeae strains from Sydney, Australia, that are less susceptible to ceftriaxone","volume":"51","author":"Whiley","year":"2007","journal-title":"Antimicrob. 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Agents"},{"key":"ref49","doi-asserted-by":"publisher","first-page":"179","DOI":"10.1097\/OLQ.0000000000000943","article-title":"Establishment of a Gonococcal antimicrobial surveillance Programme, in accordance with World Health Organization standards, in C\u00f4te d\u2019Ivoire, Western Africa, 2014\u20132017","volume":"46","author":"Y\u00e9o","year":"2019","journal-title":"Sex. Transm. Dis."}],"container-title":["Frontiers in Microbiology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmicb.2023.1163450\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,6,29]],"date-time":"2023-06-29T09:36:23Z","timestamp":1688031383000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmicb.2023.1163450\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,6,29]]},"references-count":49,"alternative-id":["10.3389\/fmicb.2023.1163450"],"URL":"https:\/\/doi.org\/10.3389\/fmicb.2023.1163450","relation":{},"ISSN":["1664-302X"],"issn-type":[{"value":"1664-302X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,6,29]]},"article-number":"1163450"}}