Nav: Home

Gonorrhea in China shows waning susceptibility to WHO-recommended antibiotics

February 06, 2018

Neisseria gonorrhoeae (N. gonorrhoeae) strains resistant to azithromycin and/or with decreased susceptibility to ceftriaxone are common in China, according to a prevalence study published this week in PLOS Medicine. The study, conducted by Yueping Yin of the National Center for STD Control & Chinese Academy of Medical Sciences & Peking Union Medical College Institute of Dermatology, Nanjing, China, and colleagues, also showed that the prevalence of dual resistance to these agents in N. gonorrhoeae isolates increased from 2013 to 2016. The results suggest that dual therapy with azithromycin and ceftriaxone, which has been recommended by WHO and many countries to treat gonorrhea, may not prove effective in China.

Antimicrobial resistance in N. gonorrhoeae is a global threat in the control of this infection. China has a high rate of antimicrobial consumption, but has limited data on antimicrobial resistance in gonorrhea. In this study, minimum inhibitory concentrations (MICs) of azithromycin and ceftriaxone were determined for 3,849 clinical isolates from patients with gonorrhea who provided samples during the time period 2013 to 2016 in 7 provinces in China. Yin and colleagues found high prevalence of resistance to azithromycin (RTA; 18.6%; 95% CI 17.4%-19.8%) and decreased susceptibility to ceftriaxone (DSC; 10.8%; 95% CI 9.9%-11.9%) in the study population. The prevalence of concomitant RTA and DSC increased from 1.9% in 2013 to 3.3% in 2016 (chi-squared test for trend, P = 0.03).

The study utilizes a convenience sample of clinical isolates, and most participants were symptomatic, heterosexual, residing in coastal locations, and male. However, to our knowledge this is the first national study on susceptibility of N. gonorrhoeae to azithromycin and ceftriaxone in China. The authors state, "It is important that clinicians be on high alert to recognize gonorrhea treatment failures so that they can be reported promptly to public health officials. The high and increasing prevalence of RTA/DSC found in the current study suggests the need for further consideration and validation of an appropriate regimen for treatment of gonorrhea in China."
Research Article


YY received funding from The Chinese Academy Medical Sciences (CAMS) Initiative for Innovative Medicine (2016-I2M-3-021). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing Interests:

The authors have declared that no competing interests exist.


Yin Y-P, Han Y, Dai X-Q, Zheng H-P, Chen S-C, Zhu B-Y, et al. (2018) Susceptibility of Neisseria gonorrhoeae to azithromycin and ceftriaxone in China: A retrospective study of national surveillance data from 2013 to 2016. PLoS Med 15(2): e1002499.

Author Affiliations:

National Center for STD Control, Chinese Center for Disease Control and Prevention, Nanjing, China
Institute of Dermatology, Chinese Academy of Medical Sciences & Peking Union Medical College, Nanjing, China
Dermatology Hospital, Southern Medical University, Guangzhou, China
Guangdong Provincial Dermatology Hospital, Guangzhou, China
Institute of Dermatology, Guangxi Autonomous Region, Nanning, China
Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, China
Hainan Provincial Center for STD/Skin Disease Control and Prevention, Haikou, China
Zhejiang Provincial Institute of Dermatology, Deqing, China
Guangzhou Institute of Dermatology, Guangzhou, China
Tianjin Center for Disease Control and Prevention, Tianjin, China
Shenzhen Center for Chronic Disease Control, Shenzhen, China
Xinjiang Center for Disease Control and Prevention, Urumqi, China



Related Azithromycin Articles:

Common antibiotic azithromycin not linked to increased risk of abnormal heartbeat
The commonly used antibiotic azithromycin is not linked to an increased risk of ventricular arrhythmia, an often life-threatening rapid, irregular heartbeat, according to a large study published in CMAJ.
Encouraging decrease in certain antibiotic resistance levels of gonococci across Europe
In 2014, the susceptibility of gonococci to two of the recommended antibiotics for gonorrhoea treatment has shown signs of improvement, according to results from the European Gonococcal Antimicrobial Surveillance Programme.
Europe sees constant increase in gonorrhoea infections
Since 2008, the overall rate of reported gonorrhea infections has more than doubled across Europe, going up from 8 per 100,000 population to 20 cases per 100,000 persons in 2014.
Common macrolide antibiotics show no increased risk of serious heart arrhythmia or death
The US Food and Drug Administration (FDA) warning about the risk of serious heart rhythm disturbances and death with macrolide antibiotics use may be overstated, according to a large study published in Canadian Medical Association Journal.
Study found adding azithromycin to standard antibiotic reduced infections in C-sections
In a study to be presented on Feb. 4 in an oral concurrent session at the Society for Maternal-Fetal Medicine's annual meeting, The Pregnancy Meeting™, in Atlanta, researchers present findings from a study that looked at the benefit of using adjunctive azithromycin to prevent infections after cesarean delivery.
Antibiotic use in early life disrupt normal gut microbiota development
The use of antibiotics in early childhood interferes with normal development of the intestinal microbiota, shows research conducted at the University of Helsinki.
Early use of antibiotic for recurrent, severe lower respiratory illness in children
Among young children with histories of recurrent severe lower respiratory tract illness (LRTI), the use of azithromycin early during an apparent RTI compared with placebo significantly reduced the risk of experiencing progression to severe LRTI, according to a study in the Nov.
For kids prone to wheezing with respiratory infections, early antibiotics help
In children whose colds tend to progress and lead to severe wheezing and difficulty breathing -- such that they are given oral corticosteroids as rescue therapy -- research led by Washington University School of Medicine in St.
Common antibiotics increase risk of cardiac arrhythmias, cardiac death
Macrolides -- a group of commonly used antibiotics for bacterial infections like pneumonia, bronchitis, and some sexually transmitted diseases -- are associated with a small but statistically significant increased risk of sudden cardiac death, according to a meta-analysis of 33 studies involving more than 20 million patients published today in the Journal of the American College of Cardiology.
Pregnancy antibiotics no cause for concern
The four out of ten women who use antibiotics during pregnancy can breathe easy, as a comprehensive new study shows that the two most often prescribed drugs have no adverse outcome on the child's physical development.

Related Azithromycin Reading:

Best Science Podcasts 2019

We have hand picked the best science podcasts for 2019. Sit back and enjoy new science podcasts updated daily from your favorite science news services and scientists.
Now Playing: TED Radio Hour

Failure can feel lonely and final. But can we learn from failure, even reframe it, to feel more like a temporary setback? This hour, TED speakers on changing a crushing defeat into a stepping stone. Guests include entrepreneur Leticia Gasca, psychology professor Alison Ledgerwood, astronomer Phil Plait, former professional athlete Charly Haversat, and UPS training manager Jon Bowers.
Now Playing: Science for the People

#524 The Human Network
What does a network of humans look like and how does it work? How does information spread? How do decisions and opinions spread? What gets distorted as it moves through the network and why? This week we dig into the ins and outs of human networks with Matthew Jackson, Professor of Economics at Stanford University and author of the book "The Human Network: How Your Social Position Determines Your Power, Beliefs, and Behaviours".