Neisseria gonorrhoeae antimicrobial drug resistance has emerged worldwide; however, the situation in sub-Saharan Africa is not well documented. We investigated the molecular epidemiology and occurrence of antimicrobial resistance in Neisseria gonorrhoeae infections in two core transmission groups of men in Johannesburg, South Africa. We recruited men who have sex with men (MSM) presenting with urethral discharge and men with recurrent episodes of urethral discharge. Molecular testing and culture for N. gonorrhoeae were performed, followed by antimicrobial susceptibility testing. Whole-genome sequencing (WGS) was used to identify resistance-conferring mutations and to determine the genetic relatedness of the isolates. In all, 51 men were recruited; 42 (82%) had N. gonorrhoeae infections. Most gonococcal isolates were resistant to ciprofloxacin (78%) and tetracycline (74%); 33% were penicillin resistant. All gonococcal isolates were susceptible to cephalosporins and spectinomycin. Azithromycin resistance was observed in 4 (15%) isolates (epidemiological cutoff), all with mutations in the mtrR promoter region. Most of the isolates (19/27) harbored the gonococcal genetic island, which is associated with antimicrobial resistance. WGS revealed a diverse epidemic with mostly novel NG-STAR (70%) and NG-MAST (70%) sequence types. Thus, we demonstrate a high prevalence of antimicrobial resistance in Neisseria gonorrhoeae strains obtained from high-risk men in South Africa. The introduction of diagnostics and scale-up of surveillance are warranted to prevent the emergence of multidrug-resistant infections.

中文翻译：

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南非约翰内斯堡的高危男子分离出淋病奈瑟氏球菌。

淋病奈瑟氏球菌的耐药性已在世界范围内出现。但是，撒哈拉以南非洲的局势没有得到充分记录。我们调查了南非约翰内斯堡两个男性核心传播人群中淋病奈瑟菌的分子流行病学和抗菌素耐药性的发生情况。我们招募了与有尿道排出物的男性发生性行为的男性（MSM）和复发性尿道排出的男性。进行了淋病奈瑟氏球菌的分子测试和培养，然后进行了抗生素敏感性测试。全基因组测序（WGS）用于鉴定赋予抗性的突变并确定分离株的遗传相关性。共有51人被招募；42（82％）有淋病奈瑟氏球菌感染。大多数淋球菌分离株对环丙沙星（78％）和四环素（74％）有抗药性。33％对青霉素耐药。所有淋球菌分离株均对头孢菌素和壮观霉素敏感。在4个（15％）分离株中发现了阿奇霉素耐药性（流行病学临界值），所有分离物均在mtrR启动子区域发生了突变。大多数分离株（19/27）都带有淋球菌遗传岛，该岛与抗菌素耐药性有关。WGS揭示了一种流行病，主要是新颖的NG-STAR（70％）和NG-MAST（70％）序列类型。因此，我们证明淋病奈瑟氏球菌具有很高的抗菌素耐药性从南非高危男子那里获得的毒株。有必要引入诊断方法和扩大监视范围，以防止出现多重耐药性感染。