Antimicrobial resistance and epidemiological aspects of Neisseria gonorrhoeae in the province of Lleida, Spain (2017-2024).

Introduction: Neisseria gonorrhoeae (NG) is one of the main causes of sexually transmitted infections and it is reaching high resistance levels worldwide. The aim of this study was to describe the antibiotic resistance, incidence and circulating sequence types of NG in the province of Lleida (Spain).

Methods: A total of 487 NG isolates were included in the study (2017-2024). Antibiotic susceptibility testing was performed by gradient diffusion following EUCAST criteria. NG-MAST was performed to 211 isolates in Centro Nacional de Microbiología (Majadahonda, Spain). The study of co-infections was done by real-time PCR (Allplex™ STI, Seegene®).

Results: All NG isolates remained susceptible to third-generation cephalosporins. The percentages of resistance to tetracycline, ciprofloxacin and penicillin G were 89.1%, 69.2% and 22.6% respectively. A 7.8% of isolates presented a MIC >1mg/L for azithromycin. A decrease in the incidence of gonococcal infections was detected during 2020, followed by a pronounced increase in next years. Ninety-seven different sequence types were detected. ST14994 (14.7%) and ST19792 (6.6%), were the most frequent ST detected in our study. NG appeared as a single STI agent in most cases (77.7%) and Chlamydia trachomatis was the most frequently detected STI agent (74.8%) in samples with co-infections.

Conclusions: NG incidence is increasing in our area. The lack of resistance to third-generation cephalosporins and the low level of azithromycin resistance suggest that the use of these antibiotics is a suitable option. Continuous surveillance is essential to prevent the emergence and spread of resistant NG isolates.