Influence of the COVID-19 pandemic on the epidemiology and resistance of neisseria gonorrhoeae in Austria

ABSTRACT

Background Gonorrhoea is a health threat, infection levels and drug resistances increased over the last decades. The COVID- 19 pandemic that hit Austria in 2020 led to several lockdown events such as closing of bars, clubs, hotels and the order to stay at home. The current study was designed to elucidate the influence of these measures in order to curtail the pandemic on the number of N. gonorrhoeae diagnosed and their respective resistance patterns. Methods Retrospective data of patients positive for N. gonorrhoeae and resistances to ceftriaxone, cefixime, azithromycin and penicillin were compared using data from 2019 and 2020 collected in and sent to the Outpatients Centre for Infectious Venero-dermatological Diseases in Vienna. Resistance testing was carried out by means of the Etest®;MIC values were interpreted according to EUCAST guidelines. Results Numbers of patients tested positive for N. gonorrhoeae declined dramatically from 639 in 2019 to 381 in 2020. The most prominent reduction was during the first lockdown (March to May 2020), with half as many gonococcal infections compared to this period in 2019. The second lockdown (November/December 2020) did not result in significantly lower numbers of gonococcal infected patients. In both years, no ceftriaxone-resistant isolate was detected. However, 2.3% of isolates from women showed borderline susceptibility (MIC = 0.094 and 0.125mg/ml), compared to 0.4% of isolates from men. During the two years of evaluation, cefixime and azithromycin resistant strains decreased (4% to 0% and 19% to 7%, respectively), while penicillin-resistant strains increased from 9% to 20%. Conclusion The first lockdown resulted in a decrease of 62.7% of infected individuals. A remarkable decrease of resistant gonococcal strains to azithromycin and no resistance to cefixime occurred in 2020. This is in contrast to an increase of resistances until 2019. Increasing numbers of isolates of women approached the MIC breakpoint for ceftriaxone..