Emergence and Spread of Cephalosporin-Resistant Neisseria gonorrhoeae with Mosaic penA Alleles, South Korea, 2012–2017

• Main Authors: Hyukmin Lee, Young Hee Suh, Sunhwa Lee, Yong-Kyun Kim, Mi-Soon Han, Hye Gyung Bae, Magnus Unemo, Kyungwon Lee
• Format: Article
• Language: English
• Published: Centers for Disease Control and Prevention 2019-03-01
• Series: Emerging Infectious Diseases
• Subjects: Neisseria gonorrhoeae; gonorrhea; antimicrobial treatment; antimicrobial resistance; ceftriaxone; cefixime
• Online Access: https://wwwnc.cdc.gov/eid/article/25/3/18-1503_article

In South Korea, surveillance of antimicrobial drug resistance in Neisseria gonorrhoeae is extremely limited. We describe the emergence and subsequent national spread of N. gonorrhoeae strains with mosaic penA alleles associated with decreased susceptibility and resistance to extended-spectrum cephalosporins. From 2012 through 2017, the proportion of mosaic penA alleles in gonococcal-positive nucleic acid amplification test (NAAT) specimens across South Korea increased from 1.1% to 23.9%. Gonococcal strains with mosaic penA alleles emerged in the international hubs of Seoul in Gyeonggi Province and Busan in South Gyeongsang Province and subsequently spread across South Korea. Most common was mosaic penA-10.001 (n = 572 isolates; 94.7%), which is associated with cefixime resistance. We also identified mosaic penA-34.001 and penA-60.001, both of which are associated with multidrug-resistant gonococcal strains and spread of cefixime and ceftriaxone resistance. Implementation of molecular resistance prediction from N. gonorrhoeae–positive nucleic acid amplification test specimens is imperative in South Korea and internationally.