Background. In Australia, rates of Neisseria gonorrhoeae (NG) notifications are increasing each year. Our previous work showed that certain pan-susceptible strains comprise high proportions of local NG strains circulating in our population. Here we investigated NG transmission and circulating genotypes throughout Queensland amongst several time periods; the years 2012 and 2018. Additionally, we sought to assess the impact of COVID-19 restrictions on NG transmission in Qld 2020.
Methods. Qld NG Isolates from the years 2012 (first 6 months; n=327), 2018 (n=1,211) and 2020 (first 6 months;n=763) were genotyped and changes in distribution were assessed throughout South East Queensland (SEQ) in comparison to non-SEQ (North/Far North/Regional). Further, isolates for the year 2020 were divided into two groups, 'Pre' (n=463) and 'Post' (n=300) COVID-19 and genotype rates and distribution were assessed.
Results. A notable expansion of heterosexual networks, specifically the second largest genotype of its size (Qld02) comprising near equal male/female ratios significantly expanded between 2012 and 2018 in SEQ (p<0.05;95% CI). The most common genotype, Qld01, was not present in our 2012 isolate population, and had spiked to 188 isolates by 2018 (p<0.05; 95% CI), with SEQ male majority. Both Qld01 and 02 were phenotypically susceptible to all antimicrobials and their significant rise by 2018 may explain the recent proportional reduction in AMR in Qld. In 2020 most common genotypes remained stable for both pre and post COVID19 restrictions, and interestingly, some significantly increased in ‘post’ time point with susceptible genotypes still dominating the landscape. However, the overall genotype diversity significantly decreased 'post' COVID-19 restrictions.
Conclusion. This data suggest that although NG notifications are still on the rise, it is not all doom and gloom when it comes to AMR. It reinforces the feasibility of recycling old antimicrobials via individualised theapy as well as raises questions over potentially increased fitness of these common genotypes which allows this enhanced transmission.