Antimicrobial resistance and molecular characteristics of N. gonorrhoea isolates in Ghana

Gonorrhoea is a disease associated with humans and it is caused by N. gonorrhoea. N. gonorrhoea’s ability to evolve and evade various treatment regimens can lead to untreatable Gonorrhoea disease. In the absence of a viable vaccine, national database on antimicrobial resistance (AMR) and molecular characteristics of N. gonorrhoea, and the reliance on syndromic management regimes, continuous national antimicrobial resistance surveillance and molecular characterisation of N. gonorrhoea remain imperative. Only two gonococcal data describing its molecular characteristics links to AMR have been reported in Ghana. Secondary N. gonorrhoea isolates (n=4) were collected from two metropolises in Ghana: Tamale in the northern sector (n=1), and Accra in the southern sector (n=3). The isolates were characterised using polymerase chain reaction (PCR) targeting the porB and tbpB genes, and the disk diffusion method was used to evaluate antimicrobial resistance (AMR). NG-MAST and porB gene sequence analysis was used to reveal molecular epidemiology and evolutionary trajectory, respectively. All four isolates showed multidrug resistance to at least four antibiotics. One isolate showed resistance to all seven antibiotics including ciprofloxacin, ceftriaxone, and azithromycin.  NG-MAST typing revealed isolates S3 (MZ313864) as ST211 while the locus of S2 (MZ313863) (tbpB) was identified as tbpB1844 but not its porB locus. Isolate S3 (MZ313864) is globally known while S2 (MZ313863) is not previously known. Multidrug-resistance and previously unknown gonococcal variant was recorded. Therefore, continuous AMR and molecular surveillance in Ghana is essential to compliment the syndromic management regime.