National Reference Centre for Neisseria gonorrhoeae (NRCNG)

In the context of the activities of the Laboratory of Bacteriology and based on the expertise in the research field of bacterial resistance to antibiotics, the National Reference Centre for Neisseria gonorrhoeae (NRCNG) is functioning under authorization of the Greek Ministry of Health (Decision Α1/5755/15-6-1987). The NRCNG carries out continuous surveillance of the epidemiological trends and microbiological characteristics of gonorrhoea in Greece. The NRCNG further characterizes resistant strains and the mechanisms responsible for the emergence and spread of antimicrobial resistance among gonococci circulating in the Greek community.

The aforementioned activities are conducted in order to notify the emergence and spread of resistant strains. The NRCNG has been appointed as the national contact point for European Centre for Disease Prevention and Control (ECDC) and participates in the Microbiology Project of the European Network for Surveillance of Sexually Transmitted Infections and the related European Gonococcal Antimicrobial Susceptibility Surveillance Program (Euro-GASP).

Activities of the NRCNG for the years 2018-2021, as summarized in the Table below, include:  
•    Systematic collection of gonococcal isolates and data for gonorrhoea cases diagnosed throughout Greece; 
•    Susceptibility testing against the antibiotics that are clinically available for gonorrhoea therapy; 
•    Typing of gonococci using conventional, molecular and sequence-based molecular methodologies;
•    Investigation of resistance mechanisms in selected isolates exhibiting new or rare patterns of resistance; 
•    Since 2019 Next Generation Sequencing techniques (WGS) were implemented for the molecular typing of N. gonorrhoeae isolates and the determination of resistance genes;  
•    Analysis of epidemiological, microbiological and genomic data for N. gonorrhoeae population; 
•    Participation in the External Quality Assurance Programme (EQA) organized and supervised by ECDC for the intra-European evaluation and quality assurance of laboratory methods for antibiotic susceptibility testing for Neisseria gonorrhoeae.
•    Annual reports to the national (Greek Ministry of Health) and international (ECDC) Health Authorities;
•    Results of the NRCNG are disseminated to the scientific community through publications and presentations; 
•    Simplified versions of the reports of the NRCNG are on the website of the HPI and are available to the public.
•    Isolates/clones of interest are also reported in the Epidemic Intelligence Information System for Sexually Transmitted Infections (EPIS-STI) –a web-based communication platform that allows members of the Euro-GASP network to report unusual events related to gonococcal resistance.
On the basis of surveillance data for antimicrobial susceptibility of gonococcal population in Greece, provided by the NRCNG, the empirical treatment of gonorrhoea patients is guided at national level.

• STI Surveillance Network: ECDC-coordinated (European Centre for Disease Prevention and Control) network for Sexually Transmitted Infections. HPI’s contribution is on gonococcal epidemiology and antimicrobial susceptibility surveillance across Europe (since 2002).
• Euro-GASP (European Gonococcal Antimicrobial Surveillance Programme): European Antimicrobial Susceptibility Surveillance Program Network running in the framework of the above mentioned STI Surveillance Program since 2005 and adopted by the ECDC in 2009.
• EPIS-STI (Epidemic Intelligence Information System for Sexually Transmitted Infections): a web-based communication platform that allows nominated members of the European STI Surveillance and Euro-GASP networks to report and disseminate immediately unusual events related to STI transmission across the EU and to assess whether current and emerging public health threats have a potential impact in the European Union 
• EQA: External Quality Assurance Program organized and supervised by ECDC for the intra-European evaluation and quality assurance of laboratory methods for antibiotic susceptibility testing in Neisseria gonorrhoeae

Publications 2018-2023

2022

• Sánchez-Busó L, Cole MJ, Spiteri G, Day M, Jacobsson S, Golparian D, Sajedi N, Yeats CA, Abudahab K, Underwood A, Bluemel B, Aanensen DM, Unemo M; Centre for Genomic Pathogen Surveillance and the Euro-GASP study group. Europe-wide expansion and eradication of multidrug-resistant Neisseria gonorrhoeae lineages: a genomic surveillance study. Lancet Microbe. 2022, 3(6):e452-e463. [https://doi.org/10.1016/S2666-5247(22)00044-1]. (collaborative)
• Day MJ, Jacobsson S, Spiteri G, Kulishev C, Sajedi N, Woodford N, Blumel B, van der Werf MJ, Amato-Gauci AJ, Unemo M, Cole MJ; Euro-GASP network. Significant increase in azithromycin "resistance" and susceptibility to ceftriaxone and cefixime in Neisseriaonorrhoeae isolates in 26 European countries, 2019. BMC Infect Dis. 2022, 22(1):524. [https://doi.org/10.1186/s12879-022-07509-w]. (collaborative)

2021

• Hadad R, Cole MJ, Ebeyan S, Jacobsson S, Tan LY, Golparian D, Erskine S, Day M, Whiley D, Unemo M; European collaborative group. Evaluation of the SpeeDx ResistancePlus® GC and SpeeDx GC 23S 2611 (beta) molecular assays for prediction of antimicrobial resistance/ susceptibility to ciprofloxacin and azithromycin in Neisseria gonorrhoeae. Journal of Αntimicrobial Chemotherapy 2021, 76(1):84-90 [https://doi.org/10.1093/jac/dkaa381]. (collaborative)
• Unemo M, Ahlstrand J, Sánchez-Busó L, Day M, Aanensen D, Golparian D, Jacobsson S, Cole MJ; European Collaborative Group. High susceptibility to zoliflodacin and conserved target (GyrB) for zoliflodacin among 1209 consecutive clinical Neisseria gonorrhoeae isolates from 25 European countries, 2018. Journal of Antimicrobial Chemotherapy 2021, 76(5):1221-1228 [https://doi.org/10.1093/jac/dkab024]. (collaborative)
• Jacobsson S, Cole MJ, Spiteri G, Day M, Unemo M; Euro-GASP Network. Associations between antimicrobial susceptibility/resistance of Neisseria gonorrhoeae isolates in European Union/European Economic Area and patients' gender, sexual orientation and anatomical site of infection, 2009-2016. BMC Infectious Diseases 2021, 21(1):273 [https://doi.org/10.1186/s12879-021-05931-0]. (collaborative)

2019

• Cole MJ, Quaye N, Jacobsson S, Day M, Fagan E, Ison C, Pitt R, Seaton S, Woodford N, Stary A, Pleininger S, Crucitti T, Hunjak B, Maikanti P, Hoffmann S, Viktorova J, Buder S, Kohl P, Tzelepi E, Siatravani E, Balla E, Hauksdóttir GS, Rose L, Stefanelli P, Carannante A, Pakarna G, Mifsud F, Cassar RZ, Linde I, Bergheim T, Steinbakk M, Mlynarczyk-Bonikowska B, Borrego MJ, Shepherd J, Pavlik P, Jeverica S, Vazquez J, Abad R, Weiss S, Spiteri G, Unemo M. Ten years of external quality assessment (EQA) of Neisseria gonorrhoeae antimicrobial susceptibility testing in Europe elucidate high reliability of data. BMC Infectious Diseases 2019, 19(1):281 [https://doi.org 10.1186/s12879-019-3900-z]. (collaborative)
• Cole MJ, Quinten C, Jacobsson S, Day M, Amato-Gauci AJ, Woodford N, Spiteri G, Unemo M; Euro-GASP network. The European gonococcal antimicrobial surveillance programme (Euro-GASP) appropriately reflects the antimicrobial resistance situation for Neisseria gonorrhoeae in the European Union/European Economic Area. BMC Infectious Diseases 2019, 19(1):1040 [https://doi.org/10.1186/s12879-019-4631-x]. (collaborative)

2018

• Harris SR, Cole MJ, Spiteri G, Sánchez-Busó L, Golparian D, Jacobsson S, Goater R, Abudahab K, Yeats CA, Bercot B, Borrego M-J, Crowley B, Stefanelli P, Tripodo F, Abad R, Aanensen DM, Unemo M, Euro-GASP study group. Public health surveillance of multidrug-resistant clones of Neisseria gonorrhoeae in Europe: a genomic survey. The Lancet Infectious Diseases 2018, 18(7):758-768 [https://doi.org/10.1016/S1473-3099(18)30225-1]. (collaborative)
• Day MJ, Spiteri G, Jacobsson S, Woodford N, Amato-Gauci AJ, Cole MJ, Unemo M; Euro-GASP network. Stably high azithromycin resistance and decreasing ceftriaxone susceptibility in Neisseria gonorrhoeae in 25 European countries, 2016. BMC Infectious Diseases 2018, 18(1):609 [https://doi.org/10.1186/s12879-018-3528-4]. (collaborative)

B. Other Publications 2018-2023

ECDC-published reports of ESSTI and Euro-GASP Networks (www.ecdc.europa.eu)

• ECDC (2022). Euro-GASP external quality assessment scheme for Neisseria gonorrhoeae antimicrobial susceptibility testing 2021. Stockholm: ECDC; 2022.
• ECDC (2022). Gonococcal antimicrobial susceptibility surveillance in the European Union/European Economic Area - Summary of results for 2020. Stockholm: ECDC; 2022.
• ECDC (2021). Euro-GASP external quality assessment scheme for Neisseria gonorrhoeae antimicrobial susceptibility testing 2019. Stockholm: ECDC; 2021.
• ECDC (2021). Gonococcal antimicrobial susceptibility surveillance in the European Union/ European Economic Area, 2019. Stockholm: ECDC; 2021.
• ECDC (2020). Gonococcal antimicrobial susceptibility surveillance in Europe, 2018. Stockholm: ECDC; 2020.
• ECDC (2019). Euro-GASP external quality assessment scheme, 2018 for Neisseria gonorrhoeae antimicrobial susceptibility testing. Stockholm: ECDC; 2019.
• ECDC (2019). Gonococcal antimicrobial susceptibility surveillance in Europe, 2017. Stockholm: ECDC; 2019.
• ECDC (2019). Gonorrhoea - Annual epidemiological report for 2017. Stockholm: ECDC; 2019.
• ECDC (2018). Gonococcal antimicrobial susceptibility surveillance in Europe, 2016. Stockholm: ECDC; 2018.
• ECDC (2018). Molecular typing of Neisseria gonorrhoeae– a study of 2013 isolates. Stockholm: ECDC; 2018.