Antimicrobial resistance of Neisseria gonorrhoeae isolates from high risk men in Johannesburg, South Africa.

Objectives. 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.Methods. We recruited men who have sex with men (MSM) presenting with urethral discharge and men with a recurrent episode of urethral discharge. Molecular testing and culture for N. gonorrhoeae followed by antimicrobial susceptibility testing was performed. Whole genome sequencing (WGS) was used to identify resistance conferring mutations and to determine genetic relatedness of the isolates.Results. Fifty-one men were recruited; 42 (82%) had N. gonorrhoeae infection. Most gonococcal isolates were resistant to ciprofloxacin (78%) and tetracycline (74%); 33% were penicillin resistant. All gonococcal isolates were susceptible to cephalosporines and spectinomycin. Azithromycin resistance was observed in four (15%) isolates (epidemiological cut-off); all with mutations in the mtrR promoter region. Most of the isolates (19/27) harboured the gonococcal genetic island; associated with antimicrobial resistance. WGS revealed a diverse epidemic with mostly novel NG-STAR (70%) and NG-MAST (70%) sequence types.Conclusions. We demonstrate high prevalence of antimicrobial-resistance in Neisseria gonorrhoeae strains obtained from high-risk men in South Africa. Introduction of diagnostics and scale-up of surveillance are warranted to prevent emergence of multidrug-resistant infections.