Neisseria gonorrhoeae in Six University Hospital STI Clinics in Sweden – Distribution, Antimicrobial Resistance and Treatment

Gonorrhoea is a sexually transmitted infection caused by Neisseria gonorrhoeae with an increasing incidence and a widespread antimicrobial resistance. The aim was to investigate the case burden, distribution of infection site, management and antibiotic resistance in N. gonorrhoeae cases in 6 university hospitals in Sweden. Diagnosis of N. gonorrhoeae was made by nucleic acid amplification tests (NAAT). Included were 1,060 cases with 27.3% women, 72.4% men and 4 transgender persons, constituting around one third of all 3,356 N. gonorrhoeae cases in Sweden 2022. The NAAT test for N. gonorrhoeae from urine was positive in 51.7% (428/828), 40.4% (428/1,060) among the total included population, from vagina/cervix in 87.9% (246/280), 23.2% (246/1,060) in the total population and from rectum in 66.1% (353/534), 33.3% (353/1,060) among all included cases, with 78.9% (277/351) positive rectal samples in men and 21.1% (74/351) in women (p<0.001), the majority being among men having sex with men (76.5%). Antimicrobial resistance was most common against ciprofloxacin, seen in 43.7% (463/1,060) and second most common against azithromycin, in 9.4% (150/1,060). The study elucidates the complexity of handling gonococcal infections regarding relevant test methods, infections in several locations and the problem with antibiotic resistance.