Table 1.
Mechanisms of antibiotic resistance in Neisseria gonorrhoeae
| Drug | MIC breakpoints137 (μg/mL) S, R | Gene (codon/allele) | Mechanism | Year |
|---|---|---|---|---|
| Sulfonamides | folP (R228)138,139 | TM | 2005 | |
|
| ||||
| Penicillin (PEN) | ≤0.06, ≥2 | penA45,140 | TM | 1975 |
| porB (G120K, A121D/N)140,141 | P | 1975 | ||
| mtrR (A39T, G45D, 1 bp del in promoter)140,142–144 | E | 1975 | ||
| blaTEM61 | I | 1976 | ||
| ponA (L421P)87 | TM | 2002 | ||
| pilQ (E666K)87,88 | P | 2002 | ||
|
| ||||
| Tetracycline (TET) | ≤0.25, ≥2 | porB (G120K, A121D/N)140,141 | P | 1975 |
| mtrR (A39T, G45D, 1 bp del in promoter)140,142–144 | E | 1975 | ||
| tetM32 | TM | 1986 | ||
| pilQ (E666K)87,88 | P | 2002 | ||
| rpsJ (V57M)145,146 | TM | 1974 | ||
|
| ||||
| Ciprofloxacin (CIP) | ≤0.06, ≥1 | gyrA (S91F, D95A/N/G)147,148 | TM | 1994 |
| parC (D86N, S87R/N, S88P, E91K)147,149 | TM | 1994 | ||
| parE (G410V)148 | TM | 2002 | ||
| norM (−35 promoter sequence, RBS)150 | E | 2003 | ||
|
| ||||
| Spectinomycin | ≤32, ≥128 | rpsE (T24P, deletion V27, A82G)151,152 | TM | 2013 |
| 16S rDNA (C1187)153 | TM | 2000 | ||
|
| ||||
| Azithromycin (AZI) | mtrR (A39T, G45D, 1 bp del in promoter)140,142–144 | E | 1975 | |
| mosaic mtr operon47 | E | 2016 | ||
| ermBCF57 | I | 1999 | ||
| 23S rDNA (C2611T, A2059G)154,155 | TM | 2002 | ||
| mef156 | E | 2000 | ||
| macAB (−10 promoter sequence)150 | E | 2003 | ||
| rplV (3′ tandem duplications)22 | TM | 2016 | ||
| rplD (G68, G70)22 | TM | 2016 | ||
|
| ||||
| Cefixime (CFX) | ≤0.25, - | mosaic penA46,157 | TM | 2002 |
|
| ||||
| Ceftriaxone (CRO) | ≤0.25*, - | mosaic penA157 | TM | 2005 |
| porB158 | P | 2009 | ||
| mtrR158 | E | 2009 | ||
TM = target modification, P = permeability, E = efflux, I = inactivation.
*
Reduced susceptibility to CRO is also described as ≥0.125 μg/mL