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Epidemiology & Monitoring

Category: Gonorrhoea - AMR

(P57) Antimicrobial Resistance of Neisseria gonorrhoeae in Germany 2016-2022

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


Background: In Germany, we established a sentinel surveillance system (Go-Surv-AMR) in 2016 in order to monitor the antimicrobial resistance (AMR) of Neisseria gonorrhoeae (NG). In addition, reporting of NG with resistance to Azithromycin, Cefixime or Ceftriaxone is mandatory In Germany since March 2020.




Methods: Between 2016-2022, 70 Go-Surv-AMR participating laboratories sent NG-isolates to the Robert Koch Institute which were tested for ceftriaxone, cefixime, azithromycin, ciprofloxacin, and penicillin susceptibility using MICstrip test. AMR-results were interpreted according to EUCAST breakpoint table version 12.0. The proportion of resistant isolates was calculated.

Mandatory notifications of resistant isolates were collected between 2020 and 2022.




Results: In the scope of Go-Surv-AMR, 3675 isolates were tested between January 2016 and December 2022. Of these, 80.1% were from men. Median age was 33 (men) and 29 years (women). Most isolates were urethral (74.9%), followed by cervical (5.5%) and rectal samples (4.8%). Cefixime-resistance was stably low from 2016-2022 (Table 1), two isolates in total (2018, 2022) were resistant to ceftriaxone. We observed high ciprofloxacin and penicillin resistance in all years. Azithromycin resistance was steadily increasing. Detailed analysis of minimum inhibitory concentration showed that this was due to isolates within the range of 1-2 mg/L.


In 2021, 397 mandatory notifications of resistant isolates were received, notifications nearly doubled in 2022 (n=776). In 2021, 91.2% were from men. For 41% of male cases transmission by sexual contact between men (MSM) was reported (28%: heterosexual contact, 32%: unknown). The highest incidence (2.9 cases/100,000 inhabitants) in men was observed in the age group 25-29 years. Resistance to azithromycin was reported in 93% of cases in 2021, cefixime in 5% and ceftriaxone in 0.5%.



Conclusion: Comparable to other Western countries, the majority of notifications and isolates received originated from men. Ceftriaxone as first-line therapy remains effective in Germany throughout all years. In contrast, resistance to the dual first-line therapy component azithromycin reached a high level. Currently, ceftriaxone monotherapy is recommended in Germany since 2019 if patient adherence is warranted. NG susceptibility testing and surveillance are crucial to monitor the AMR-situation and to inform up-to-date treatment guidelines.