The first European-wide genomic survey of gonorrhoea has mapped antibiotic resistance in this sexually transmitted disease throughout the continent. Researchers at The Centre for Genomic Pathogen Surveillance (CGPS), the Wellcome Sanger Institute, European Centre for Disease Control, and their collaborators also showed that using DNA sequencing data they could accurately determine antibiotic resistance and identify incorrect laboratory test results. This genomic approach could one day help doctors prescribe the most effective antibiotics for each region.
Reported in The Lancet Infectious Diseases, the study has also established an open genomic database of gonorrhoea. The new resource will support real-time ongoing surveillance of gonorrhoea worldwide, which public health officials could use to monitor which strains of gonorrhoea are present globally and where new antibiotic resistance is emerging.
Gonorrhoea is the second most prevalent bacterial sexually transmitted infection (STI) globally and is caused by the bacterium Neisseria gonorrhoeae. The WHO estimates that gonorrhoea infects 88 million people globally each year. Amongst other complications, it can cause pelvic inflammatory disease and infertility if left untreated, and in some cases leads to life-threatening complications such as meningitis. Transmitted during unprotected sex, many strains of gonorrhoea are now difficult to treat due to the rise in antibiotic resistance.
To understand the extent of multidrug resistant strains and determine the best method for surveillance, the researchers studied 1054 samples of N. gonorrhoeae collected from 20 countries across Europe in 2013*. Each sample was tested locally for type and antibiotic sensitivity, and was sent to a central laboratory for DNA extraction. The DNA was then sequenced and the data analysed at the Centre for Genomic Pathogen Surveillance and made accessible via their online platform, creating the first European-wide database of gonorrhoea.
The scientists discovered that using genomic data allowed them to identify clinically important, antibiotic resistant strains much more accurately than existing typing techniques, and to identify incorrect laboratory antibiotic resistance results.
Prof David Aanensen, a corresponding author on the paper and Director of The Centre for Genomic Pathogen Surveillance, Wellcome Sanger Institute, said: "Ours is the most comprehensive, structured genomic study of gonorrhoea to date, and data are available to healthcare workers worldwide to compare and view emerging strains of gonorrhoea. This combination of a new method with an accessible database and interpretation tools provides a genomic baseline of gonorrhoea strains and antibiotic resistance across Europe, which will strengthen real-time, surveillance of gonorrhoea.
Dr Simon Harris, first author on the paper from the Wellcome Sanger Institute, said: "Our study shows that current methods for typing strains of gonorrhoea are not very effective for surveillance. We show that whole genome sequencing gives a true picture of where sensitive and resistant strains are circulating, which will allow doctors to quickly spot the emergence of new, antibiotic resistant gonorrhoea strains. A follow up study starting this year will show how the picture changes with time."
The web application is openly available online, and healthcare officials from around the world can use it and add their own genomic data. This will enable them to monitor the strains and antibiotic resistance emerging in each geographic area. Ongoing surveillance would allow clinics to offer the most appropriate antibiotics and help to delay the onset of further antibiotic resistance.
Dr Gianfranco Spiteri, an author on the paper from the European Centre for Disease Prevention and Control which co-ordinates the European Gonococcal Antimicrobial Surveillance Programme (Euro-GASP), said: "Drug-resistant bacteria are becoming a huge public health threat. To control them, we badly need new tools to identify and track new infections and antibiotic resistant strains. This new approach will allow European-wide genomic surveillance of gonorrhoea which directly influences infection control on a national level and helps to prevent gonorrhoea. This approach can also be expanded to other infections."
Notes to Editors:
*The European Gonococcal Antimicrobial Surveillance Programme (Euro-GASP) monitors antimicrobial resistance in the European Union and European economic area.
The Centre for Genomic Pathogen Surveillance (CGPS)
The Centre for Genomic Pathogen Surveillance is an initiative based at the Wellcome Sanger Institute and the Big Data Institute at the University of Oxford, focussed on genomic epidemiology, laboratory and software engineering for global surveillance of microbial pathogens. The Centre seeks to provide genomic and epidemiological big data and tools to allow researchers, doctors and governments worldwide to track and analyse the spread of pathogens and antimicrobial resistance through strategic partnerships. The Centre also houses the NIHR Global Health Research Unit of Genomic Surveillance of AMR. http://pathogensurveillance.net
The European Centre for Disease Prevention and Control (ECDC)
The European Centre for Disease Prevention and Control (ECDC) is an EU agency tasked with identifying, assessing and communicating threats to human health posed by infectious diseases. It supports the work of public health authorities in the EU and EEA Member States. https://ecdc.europa.eu/en/home
The European Gonococcal Antimicrobial Surveillance Programme (Euro-GASP)
The European Gonococcal Antimicrobial Surveillance Programme (Euro-GASP), co-ordinated by the European Centre for Disease Prevention and Control, annually monitors emerging resistance trends by testing susceptibility of the recommended antimicrobial agents for gonorrhoea treatment - which is vital to guide clinical services to ensure that patients are successfully treated and the risk of complications are avoided. https://ecdc.europa.eu/en/about-us/partnerships-and-networks/disease-and-laboratory-networks/euro-gasp
Wellcome Sanger Institute
The Wellcome Sanger Institute is one of the world's leading genome centres. Through its ability to conduct research at scale, it is able to engage in bold and long-term exploratory projects that are designed to influence and empower medical science globally. Institute research findings, generated through its own research programmes and through its leading role in international consortia, are being used to develop new diagnostics and treatments for human disease. To celebrate its 25th year in 2018, the Institute is sequencing 25 new genomes of species in the UK. Find out more at http://www.sanger.ac.uk or follow @sangerinstitute
Wellcome exists to improve health for everyone by helping great ideas to thrive. We're a global charitable foundation, both politically and financially independent. We support scientists and researchers, take on big problems, fuel imaginations and spark debate. http://www.wellcome.ac.uk
The Lancet Infectious Diseases