Phylogenomic analysis reveals persistence of gonococcal strains with reduced-susceptibility to extended-spectrum cephalosporins and mosaic penA-34

Jesse C. Thomas (), Sandeep J. Joseph, John C. Cartee, Cau D. Pham, Matthew W. Schmerer, Karen Schlanger, Sancta B. St. Cyr, Ellen N. Kersh and Brian H. Raphael
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Jesse C. Thomas: Centers for Disease Control and Prevention
Sandeep J. Joseph: Centers for Disease Control and Prevention
John C. Cartee: Centers for Disease Control and Prevention
Cau D. Pham: Centers for Disease Control and Prevention
Matthew W. Schmerer: Centers for Disease Control and Prevention
Karen Schlanger: Centers for Disease Control and Prevention
Sancta B. St. Cyr: Centers for Disease Control and Prevention
Ellen N. Kersh: Centers for Disease Control and Prevention
Brian H. Raphael: Centers for Disease Control and Prevention

Nature Communications, 2021, vol. 12, issue 1, 1-9

Abstract: Abstract The recent emergence of strains of Neisseria gonorrhoeae associated with treatment failures to ceftriaxone, the foundation of current treatment options, has raised concerns over a future of untreatable gonorrhea. Current global data on gonococcal strains suggest that several lineages, predominately characterized by mosaic penA alleles, are associated with elevated minimum inhibitory concentrations (MICs) to extended spectrum cephalosporins (ESCs). Here we report on whole genome sequences of 813 N. gonorrhoeae isolates collected through the Gonococcal Isolate Surveillance Project in the United States. Phylogenomic analysis revealed that one persisting lineage (Clade A, multi-locus sequence type [MLST] ST1901) with mosaic penA-34 alleles, contained the majority of isolates with elevated MICs to ESCs. We provide evidence that an ancestor to the globally circulating MLST ST1901 clones potentially emerged around the early to mid-20th century (1944, credibility intervals [CI]: 1935–1953), predating the introduction of cephalosporins, but coinciding with the use of penicillin. Such results indicate that drugs with novel mechanisms of action are needed as these strains continue to persist and disseminate globally.

Date: 2021
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DOI: 10.1038/s41467-021-24072-1

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