The Gonococcal antibiotic surveillance in Scotland (GASS) report was published on 31 July 2018, showing the patterns and trends of antibiotic resistance in 2017. In the UK, the current recommended treatment for gonorrhoea is dual therapy with ceftriaxone and azithromycin, with patterns of resistance measured each year to ensure treatment remains effective. In 2017, no resistance to ceftriaxone was observed, however decreased susceptibility to azithromycin was observed in a small proportion (3.4%) of isolates. Of concern, however, was the observation that a small number (21, 1.6%) of gonococcal isolates demonstrated high level resistance (HL-AziR) to azithromycin. This is an increase on previous years and is the highest number and proportion since a similar observation was made in 2007.
High level azithromycin resistant strains are also circulating in England. Encouragingly, to date in Scotland, no treatment failures have been formally reported. However, it is essential that resistance monitoring continues to help guide effective antibiotic therapy. An expert group has been established by HPS to examine the data further and make recommendations on treatment based on emerging patterns of decreased susceptibility and resistance.