Introduction:The human restricted pathogen Neisseria gonorrhoeae (NG) is the causative agent of the sexually transmitted infection (STI) gonorrhoea. With over 83 million infections annually, gonorrhoea is one of the most prevalent STI on a global scale. The rise of antimicrobial resistance (AMR) to all antibiotic classes used to treat NG infections makes management and treatment of NG infections increasingly complex. The pharynx represents a potential reservoir for AMR due to its poor accessibility for antibiotics and the possibility of horizontal gene transfer of AMR determinants from commensal Neisseria species. Yet, few data on AMR of NG isolated from the pharynx are available as most NG infections of the pharynx are asymptomatic and culture is further impeded by often low bacterial load and surrounding microbiota.

Goals:The study Go-Pharynx aims to improve culture methodology of NG isolation from the pharynx and to gain insight into the prevalence of NG-AMR in the pharynx as well as identify potential epidemiological risk factors for NG-AMR.

Methods:Partner clinics in Berlin recruit participants that either present with a symptomatic NG infection or that tested positive for NG in an STI screening. Clinicians and participants answer clinical and epidemiological questionnaires and two pharyngeal swabs are taken. Within 24 h one swab is sent to a partner laboratory for follow-up nucleic acid amplification testing (NAAT) and the other to the RKI for culture. Culture is only pursued for NAAT positive samples. After successful isolation of NG, phenotypic AMR testing as well as whole genome sequencing (WGS) are performed. Phenotypic and genomic data are correlated to identify known and possibly knew genetic determinants of AMR. Statistical analysis of the epidemiological and laboratory data is performed to calculate the prevalence of NG-AMR in Germany and to identify predictors for its development and spread.

Summary:Determining the extent of AMR in NG isolated from the pharynx as well as identifying prognostic factors contributing to its spread is important for the implementation of public health measures for prevention and treatment of resistant pharyngeal NG.