Genotypic virulence profiles and mobile genetic elements related to invasiveness in Neisseria gonorrhoeae strains

Introduction: The increasing incidence of Neisseria gonorrhoeae (NG) has become a global health threat due to drug resistance and potentially invasive disease. Few studies in Brazil have analyzed the presence of resistance genes and its correlation with invasive clinical presentations. To assess the genotypic virulence profile in both invasive and non-invasive N. gonorrhoeae strains from patients with gonococcal disease at Hospital das Clínicas of the Faculdade de Medicina of the University of São Paulo, Brazil (HC-FMUSP). Methods: To analyze genotypic profiles of 25 NG clinical isolates from 25 hospitalized patients at Hospital das Clínicas da FMUSP from January 2017 to March 2020. The isolates were submitted to whole genome sequencing, typed by MLST and resistome analysis was performed. Results: Of the 25 isolates, 10 (40%) were from sterile sites (blood, biopsy and articular fluid) and classified as invasive. The phylogenetic tree analyses showed that invasive specimens were grouped in 5 STs (8143, 1588, 16704, 14939, 12894) and noninvasive specimens clustered in 11 STs, with 3 STs in common between the groups. The resistance genes blaTEM-1B (7% vs. 50%, p = 0.023) and the tetM (13% vs. 80%, p = 0.002) were more frequently found in isolates from patients with invasive disease and they were always accompanied by the mobile genetic elements pJD4 and pEP5289, respectively. Those elements were also associated with toxins and resistance elements described previously as possible virulence factors in vitro studies. Conclusion: Our results observed that invasive strains of NG are genotypically clustered and frequently harbor two plasmids that had never been associated with invasive disease before. These results evidence the need for more NG surveillance projects in Brazil.