OBJECTIVES: To investigate a potential outbreak of high-level @entity4580 resistant (HL-AziR) @entity2954 diagnosed in eight @entity1 attending a sexual health clinic in Leeds, North England, between November 2014 and March 2015. METHODS: Eight cases of @entity281 with gonococci exhibiting @entity4580 minimum inhibitory concentrations (MICs) >= 256   mg/L were identified from @entity1 in Leeds as part of the routine service provided by the Sexually Transmitted Bacteria Reference Unit. All @entity1 records were reviewed to collate epidemiological and clinical information including evaluation of @entity1 management. @entity5555 ( @entity5555 ) was performed on seven gonococcal isolates to determine @entity6368 multiantigen sequence type (NG-MAST), @entity5555 comparison and mutations in the 23S rRNA genes. RESULTS: All @entity1 were heterosexual (five male, three female) from a range of ethnic backgrounds and from the Leeds area. Three @entity1 were linked by partner notification. All @entity1 were infected at genital sites and two @entity1 had @entity281 also. Six @entity1 received the recommended first-line therapy for uncomplicated gonorrhoea, one was treated for pelvic @entity32 and one received @entity6760 followed later by @entity2177 . Test of cure was achieved in seven @entity1 and confirmed successful eradication. All seven isolates sequenced were identical by NG-MAST and @entity5555 comparison, and contained an @entity26121 mutation in all four 23S rRNA alleles. CONCLUSIONS: Epidemiological and microbiological investigations confirm that an outbreak of a @entity2954 showing HL-AziR is ongoing in the North of England. Every effort should be made to identify and curtail dissemination of this strain as it presents a significant threat to the current recommended front-line dual therapy.

An outbreak of high-level @entity4580 resistant XXXX in England.

@entity1 :: ('9606', 'Species') :: ['women', 'patients', 'patient'] @entity2954 :: ('MESH:D006069', 'Disease') :: ['gonococcal infections', 'gonococcal strain'] @entity32 :: ('MESH:D007249', 'Disease') :: ['inflammatory disease'] @entity6368 :: ('485', 'Species') :: ['Neisseria gonorrhoeae'] @entity5555 :: ('MESH:D042822', 'Disease') :: ['Whole-genome sequencing', 'WGS'] @entity2177 :: ('MESH:D002939', 'Chemical') :: ['ciprofloxacin'] @entity4580 :: ('MESH:D017963', 'Chemical') :: ['azithromycin'] @entity26121 :: ('c|SUB|A|2143|G', 'DNAMutation') :: ['A2143G'] @entity281 :: ('MESH:D007239', 'Disease') :: ['infection', 'pharyngeal infection'] @entity6760 :: ('MESH:D000198', 'Chemical') :: ['spectinomycin']
@entity6368 :: (485,Species) :: ['Neisseria gonorrhoeae']
