1887
  1. Home
  2. Eurosurveillance
  3. Volume 23, Issue 50, 13/Dec/2018
  4. Article
Research article Open Access
Like 0
Download

Abstract

Background

Genotyping of (NG) is essential for surveillance to monitor NG transmission and dissemination of resistant strains. Current genotyping methods rely on bacterial culture which frequently fails.

Aim

Our aim was to develop a culture-free genotyping method that is compatible with the widely used multi-antigen sequence typing (NG-MAST) database, which facilitates genotyping of NG detected at separate anatomical sites in individual patients.

Methods

Specific primers for both PCR targets and were designed and technically validated by assessing the analytical sensitivity, cross-reactivity with 32 non-gonoccocal species, and concordance with NG-MAST. Clinical application was assessed on 205 paired samples from concurrent NG infections at different anatomical sites of 98 patients (81 men who have sex with men and 17 women) visiting our sexually transmitted infections clinic.

Results

Typing could be consistently performed on samples with a PCR quantification cycle (Cq) value <35. Furthermore, the method showed no cross-reactivity and was concordant with NG-MAST. Culture-free NG-MAST improved the typing rate from 62% (59/95) for cultured samples to 94% (89/95) compared with culture-dependent NG-MAST. Paired samples of 80 of 98 patients were genotyped, revealing distinct NG strains in separate anatomical sites in 25% (20/80) of the patients.

Conclusions

This NG-specific genotyping method can improve NG surveillance as it facilitates genotyping of non-culturable and extra-genital samples. Furthermore, 25% of patients were infected with multiple NG strains, which is missed in current culture-dependent surveillance. Including non-culturable and concurrent NG infections in surveillance informs actions on dissemination of multidrug-resistant NG strains.

© Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.
Loading

Article metrics loading...

/content/10.2807/1560-7917.ES.2018.23.50.1800253
2018-12-13
2024-04-26
http://instance.metastore.ingenta.com/content/10.2807/1560-7917.ES.2018.23.50.1800253
Loading
Loading full text...

Full text loading...

/deliver/fulltext/eurosurveillance/23/50/eurosurv-23-50-2.html?itemId=/content/10.2807/1560-7917.ES.2018.23.50.1800253&mimeType=html&fmt=ahah

References

  1. World Health Organization (WHO). Global action plan to control the spread and impact of antimicrobial resistance in Neisseria gonorrhoeae. Geneva: WHO; 2012. Available from: http://apps.who.int/iris/bitstream/handle/10665/44863/9789241503501_eng.pdf;jsessionid=DFA2F277BB3490186A525ABFEF62B3E5?sequence=1
  2. Recommendations for the laboratory-based detection of Chlamydia trachomatis and Neisseria gonorrhoeae--2014. MMWR Recomm Rep. 2014;63(RR-02):1-19.
  3. Goire N, Lahra MM, Chen M, Donovan B, Fairley CK, Guy R, et al. Molecular approaches to enhance surveillance of gonococcal antimicrobial resistance. Nat Rev Microbiol. 2014;12(3):223-9.  https://doi.org/10.1038/nrmicro3217  PMID: 24509781 
  4. Visser M, van Aar F, Op de Coul ELM, Slurink IAL, van Wees DA, Hoenderboom BM, et al. Sexually transmitted infections in the Netherlands in 2017. Bilthoven: National Institute for Public Health and Environment; 2018. Available from: https://www.rivm.nl/bibliotheek/rapporten/2018-0012.pdf
  5. World Health Organization (WHO). WHO guidelines for the treatment of Neisseria gonorrhoeae. Geneva: WHO; 2016. Available from: http://apps.who.int/iris/bitstream/handle/10665/246114/9789241549691-eng.pdf?sequence=1
  6. Carannante A, Ghisetti V, Dal Conte I, Gregori G, Stella ML, Vacca P, et al. Molecular characterization of Neisseria gonorrhoeae on non-cultured specimens from multiple anatomic sites. Ann Ist Super Sanita. 2017;53(3):213-7. PMID: 28956800 
  7. Martin IM, Ison CA, Aanensen DM, Fenton KA, Spratt BG. Rapid sequence-based identification of gonococcal transmission clusters in a large metropolitan area. J Infect Dis. 2004;189(8):1497-505.  https://doi.org/10.1086/383047  PMID: 15073688 
  8. Unemo M, Dillon JA. Review and international recommendation of methods for typing neisseria gonorrhoeae isolates and their implications for improved knowledge of gonococcal epidemiology, treatment, and biology. Clin Microbiol Rev. 2011;24(3):447-58.  https://doi.org/10.1128/CMR.00040-10  PMID: 21734242 
  9. Kwong JC, Gonçalves da Silva A, Dyet K, Williamson DA, Stinear TP, Howden BP, et al. NGMASTER:in silico multi-antigen sequence typing for Neisseria gonorrhoeae. Microb Genom. 2016;2(8):e000076.  PMID: 28348871 
  10. Chisholm SA, Unemo M, Quaye N, Johansson E, Cole MJ, Ison CA, et al. Molecular epidemiological typing within the European Gonococcal Antimicrobial Resistance Surveillance Programme reveals predominance of a multidrug-resistant clone. Euro Surveill. 2013;18(3):20358. PMID: 23351652 
  11. Whiley DM, Goire N, Ray ES, Limnios A, Lambert SB, Nissen MD, et al. Neisseria gonorrhoeae multi-antigen sequence typing using non-cultured clinical specimens. Sex Transm Infect. 2010;86(1):51-5.  https://doi.org/10.1136/sti.2009.037689  PMID: 19843535 
  12. Dukers-Muijrers NH, Schachter J, van Liere GA, Wolffs PF, Hoebe CJ. What is needed to guide testing for anorectal and pharyngeal Chlamydia trachomatis and Neisseria gonorrhoeae in women and men? Evidence and opinion. BMC Infect Dis. 2015;15(1):533.  https://doi.org/10.1186/s12879-015-1280-6  PMID: 26576538 
  13. Chan PA, Janvier M, Alexander NE, Kojic EM, Chapin K. Recommendations for the diagnosis of Neisseria gonorrhoeae and Chlamydia trachomatis, including extra-genital sites. Med Health R I. 2012;95(8):252-4. PMID: 22970467 
  14. Unemo M, Shafer WM. Antimicrobial resistance in Neisseria gonorrhoeae in the 21st century: past, evolution, and future. Clin Microbiol Rev. 2014;27(3):587-613.  https://doi.org/10.1128/CMR.00010-14  PMID: 24982323 
  15. Bissessor M, Tabrizi SN, Fairley CK, Danielewski J, Whitton B, Bird S, et al. Differing Neisseria gonorrhoeae bacterial loads in the pharynx and rectum in men who have sex with men: implications for gonococcal detection, transmission, and control. J Clin Microbiol. 2011;49(12):4304-6.  https://doi.org/10.1128/JCM.05341-11  PMID: 21956992 
  16. Kolader ME, Dukers NH, van der Bij AK, Dierdorp M, Fennema JS, Coutinho RA, et al. Molecular epidemiology of Neisseria gonorrhoeae in Amsterdam, The Netherlands, shows distinct heterosexual and homosexual networks. J Clin Microbiol. 2006;44(8):2689-97.  https://doi.org/10.1128/JCM.02311-05  PMID: 16891479 
  17. Pond MJ, Hall CL, Miari VF, Cole M, Laing KG, Jagatia H, et al. Accurate detection of Neisseria gonorrhoeae ciprofloxacin susceptibility directly from genital and extragenital clinical samples: towards genotype-guided antimicrobial therapy. J Antimicrob Chemother. 2016;71(4):897-902.  https://doi.org/10.1093/jac/dkv432  PMID: 26817487 
  18. De Silva D, Peters J, Cole K, Cole MJ, Cresswell F, Dean G, et al. Whole-genome sequencing to determine transmission of Neisseria gonorrhoeae: an observational study. Lancet Infect Dis. 2016;16(11):1295-303.  https://doi.org/10.1016/S1473-3099(16)30157-8  PMID: 27427203 
  19. Unemo M, Golparian D, Sánchez-Busó L, Grad Y, Jacobsson S, Ohnishi M, et al. The novel 2016 WHO Neisseria gonorrhoeae reference strains for global quality assurance of laboratory investigations: phenotypic, genetic and reference genome characterization. J Antimicrob Chemother. 2016;71(11):3096-108.  https://doi.org/10.1093/jac/dkw288  PMID: 27432602 
  20. Workowski KA, Bolan GA, Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2015. MMWR Recomm Rep. 2015;64(RR-03):1-137. PMID: 26042815 
  21. European Centre for Disease Prevention and Control (ECDC). Gonococcal antimicrobial susceptibility surveillance in Europe 2015. Stockholm: ECDC; 2017. Available from: https://ecdc.europa.eu/sites/portal/files/documents/gonococcal-antimicrobial-susceptibility-surveillance-Europe-2015.pdf
  22. Cheng CW, Li LH, Su CY, Li SY, Yen MY. Changes in the six most common sequence types of Neisseria gonorrhoeae, including ST4378, identified by surveillance of antimicrobial resistance in northern Taiwan from 2006 to 2013. J Microbiol Immunol Infect. 2016;49(5):708-16.  https://doi.org/10.1016/j.jmii.2014.08.016  PMID: 25442864 
  23. Wind CM, Bruisten SM, Schim van der Loeff MF, Dierdorp M, de Vries HJC, van Dam AP. A Case-Control Study of Molecular Epidemiology in Relation to Azithromycin Resistance in Neisseria gonorrhoeae Isolates Collected in Amsterdam, the Netherlands, between 2008 and 2015. Antimicrob Agents Chemother. 2017;61(6):e02374-16.  https://doi.org/10.1128/AAC.02374-16  PMID: 28373191 
  24. Shigemura K, Osawa K, Miura M, Tanaka K, Arakawa S, Shirakawa T, et al. Azithromycin resistance and its mechanism in Neisseria gonorrhoeae strains in Hyogo, Japan. Antimicrob Agents Chemother. 2015;59(5):2695-9.  https://doi.org/10.1128/AAC.04320-14  PMID: 25712352 
  25. Brunner A, Nemes-Nikodem E, Jeney C, Szabo D, Marschalko M, Karpati S, et al. Emerging azithromycin-resistance among the Neisseria gonorrhoeae strains isolated in Hungary. Ann Clin Microbiol Antimicrob. 2016;15(1):53.  https://doi.org/10.1186/s12941-016-0166-9  PMID: 27646968 
  26. Eyre DW, Sanderson ND, Lord E, Regisford-Reimmer N, Chau K, Barker L, et al. Gonorrhoea treatment failure caused by a Neisseria gonorrhoeae strain with combined ceftriaxone and high-level azithromycin resistance, England, February 2018. Euro Surveill. 2018;23(27):1800323.  https://doi.org/10.2807/1560-7917.ES.2018.23.27.1800323  PMID: 29991383 
  27. European Centre for Disease Prevention and Control (ECDC). Molecular typing of Neisseria gonorrhoeae - a study of 2013 isolates. Stockholm: ECDC; 2018. Available from: https://ecdc.europa.eu/sites/portal/files/documents/Molecular-typing-N-gonorrhoeae-web.pdf
  28. Trembizki E, Buckley C, Donovan B, Chen M, Guy R, Kaldor J, et al. Direct real-time PCR-based detection of Neisseria gonorrhoeae 23S rRNA mutations associated with azithromycin resistance. J Antimicrob Chemother. 2015;70(12):3244-9. PMID: 26338048 
  29. Martin IM, Foreman E, Hall V, Nesbitt A, Forster G, Ison CA. Non-cultural detection and molecular genotyping of Neisseria gonorrhoeae from a piece of clothing. J Med Microbiol. 2007;56(Pt 4):487-90.  https://doi.org/10.1099/jmm.0.46956-0  PMID: 17374888 
Culture-free genotyping of Neisseria gonorrhoeae revealed distinct strains at different anatomical sites in a quarter of patients, the Netherlands, 2012 to 2016
<p class="citation"> <span>Citation style for this article:</span> <span class="meta-value authors"> <a href="/search?value1=Brian+MJW+van+der+Veer&option1=author&noRedirect=true" class="nonDisambigAuthorLink">van der Veer Brian MJW</a>, <a href="/search?value1=Petra+FG+Wolffs&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Wolffs Petra FG</a>, <a href="/search?value1=Christian+JPA+Hoebe&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Hoebe Christian JPA</a>, <a href="/search?value1=Nicole+HTM+Dukers-Muijrers&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Dukers-Muijrers Nicole HTM</a>, <a href="/search?value1=Lieke+B+van+Alphen&option1=author&noRedirect=true" class="nonDisambigAuthorLink">van Alphen Lieke B</a></span>. Culture-free genotyping of Neisseria gonorrhoeae revealed distinct strains at different anatomical sites in a quarter of patients, the Netherlands, 2012 to 2016. <a href="/content/ecdc">Euro Surveill.</a> 2018;23(50):pii=1800253. <a href="https://doi.org/10.2807/1560-7917.ES.2018.23.50.1800253" title="doi link" target="_blank">https://doi.org/10.2807/1560-7917.ES.2018.23.50.1800253</a> <span class="ES_Article_citation"> <span class="generated">Received</span>: 13 May 2018;&nbsp;&nbsp; <span class="generated">Accepted</span>: 05 Oct 2018 </span> </p>
/content/10.2807/1560-7917.ES.2018.23.50.1800253
/content/10.2807/1560-7917.ES.2018.23.50.1800253
Loading

Data & Media loading...

Submit comment
Close
Comment moderation successfully completed
This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error