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Epidemiology & Monitoring

Category: Gonorrhoea - AMR

(P66) Despite absence of ceftriaxone resistance in the Netherlands many oropharyngeal Neisseria gonorrhoeae isolates have a mosaic penA gene similar to commensal Neisseria species

Tuesday, July 25, 2023
16:00 – 18:00 CST


Background: Neisseria gonorrhoeae (NG) is increasingly resistant towards all classes of antibiotics, including ceftriaxone. Ceftriaxone resistance can occur by recombination with DNA of commensal Neisseria species forming mosaic penA genes. To study the presence of commensal Neisseria species and possible penA recombination during an oropharyngeal NG infection, penA gene and flanking regions were nanopore sequenced.



Methods: Men who have sex with men (MSM, n=57) who were tested more than once and had at least one NG positive oropharyngeal sample between January 2017 and June 2018 were selected retrospectively. NG positivity was based on the cobas 4800 CT/NG assay (Roche Diagnostics, Basel, Switzerland) and all NG positive oropharyngeal swab samples (64/176) were included. The penA gene and adjacent regions, used for species identification, were PCR amplified and nanopore sequenced. Amino acid sequences of penA were compared between Neisseria species when a mosaic gene was observed in NG.



Results: A total of 61/64 NG positive samples were penA PCR positive. In all samples N. subflava was observed, N. cinerea was present in 35/61 samples, N. elongata 31/61, N. meningitidis 29/61, N. mucosa 26/61, N. lactamica 8/61, and N. oralis 9/61. A NG consensus sequence could be constructed in 28/61 samples of which 8/28 showed mosaicism. The mosaic part was similar to a commensal Neisseria species within the same sample in all of these samples.



Conclusion: Despite no ceftriaxone resistance in the Netherlands, in 29% of the NG consensus sequences, a mosaic penA gene was observed. Our study provides further evidence that commensal Neisseria species are frequently present during a NG infection. This suggests that recombination of DNA from commensal Neisseria species could occur frequently during an oropharyngeal NG infection. Therefore, future studies should also focus on the commensal Neisseria species as they could have a pivotal role in AMR development in NG.