First Study on Antimicrobial Susceptibility and Molecular Epidemiology of Neisseria gonorrhoeae Isolates from Infertile Women

Purpose: The growing antimicrobial resistance in Neisseria gonorrhoeae ( N. gonorrhoeae ) complicates the elimination of gonococcal infections and increases the risk of female infertility. In this study, we investigated the antimicrobial susceptibility and molecular epidemiology of N. gonorrhoeae isolates obtained from infertile women in China. Methods: One hundred and six clinical isolates of N. gonorrhoeae were collected from infertile women between January 2018 and September 2022. The susceptibility of all isolates to six antibiotics (penicillin, ceftriaxone, tetracycline, azithromycin, ciprofloxacin, and spectinomycin) was determined using the agar dilution method. The molecular epidemiology of the isolates was further analyzed using N. gonorrhoeae multiantigen sequence typing (NG-MAST). Results: Isolates were resistant to ciprofloxacin (100%), tetracycline (98.1%), penicillin (79.3%), and azithromycin (19.8%). In addition, 16.0% showed decreased susceptibility to ceftriaxone and 2.8% were resistant to ceftriaxone. Notably, 2.8% of the isolates displayed both azithromycin resistance and decreased susceptibility to ceftriaxone. NG-MAST identified 83 sequence types (STs), with ST5061 and ST4539 being the most common. Conclusion: Ceftriaxone monotherapy, rather than ceftriaxone–azithromycin dual therapy, may be an appropriate option for gonorrhea treatment in infertile women. Sustained surveillance of gonococcal antimicrobial resistance in infertile populations is warranted.