Trends and risk factors of antimicrobial resistance of Neisseria gonorrhoeae in Catalonia, Spain, 2022–2023

Neisseria gonorrhoeae (NG) remains a major cause of sexually transmitted infections (STIs) in Europe. Increasing antimicrobial resistance (AMR) threatens treatments’ effectiveness and complicates control efforts. Continuous regional surveillance is essential to detect emerging trends and inform public health action. To describe NG epidemiology and AMR trends in Catalonia during 2022–2023, and identify associated resistance risk factors. Retrospective analysis of laboratory-confirmed NG cases reported to the Microbiological Reporting System of Catalonia and the STI Registry. Antimicrobial susceptibility testing (AST) was performed for seven antibiotics. Descriptive analysis and logistic regression were used to assess associations between AMR and demographic and clinical variables, including age, sex, sexual orientation and gender identity (SOGI) and anatomical site of infection. 23,968 NG cases were reported, representing an 18.9% increase in incidence from 2022 to 2023. Culture was performed in 5,158 cases, AST results were available for 4,709 isolates. Resistance was highest for ciprofloxacin (71.4%) and tetracycline (48.9%), followed by azithromycin (20.3%) and penicillin (10.2%). Cefixime and ceftriaxone resistance was negligible. Azithromycin resistance was independently associated with homosexual orientation (adjusted odds ratio (aOR): 2.08) and anal infection (aOR: 1.41). Age ≥ 25 years was associated with resistance to ciprofloxacin, tetracycline, and penicillin. High NG incidence and substantial resistance to older antibiotics, together with notable azithromycin resistance, underscore the need for sustained AMR surveillance, particularly among men who have sex with men (MSM) and in anal infections. Strengthening culture-based AMR surveillance, extragenital screening and targeted prevention strategies are essential to preserve effective treatment options.

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Journal
European Journal of Clinical Microbiology & Infectious Diseases
Published
2026-03-28
DOI
https://doi.org/10.1007/s10096-026-05456-x
Primary Topic
Reproductive tract infections research
Type
article
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article

Trends and risk factors of antimicrobial resistance of Neisseria gonorrhoeae in Catalonia, Spain, 2022–2023

Albert Sabater Barragan, Cristina Pitart, Belén Viñado, Ester del Barrio et al.
European Journal of Clinical Microbiology & Infectious Diseases
Reproductive tract infections research
article

Trends and risk factors of antimicrobial resistance of Neisseria gonorrhoeae in Catalonia, Spain, 2022–2023

Albert Sabater Barragan, Cristina Pitart, Belén Viñado, Ester del Barrio, Manuel Monsonís, Lourdes Montsant, Evelin López-Corbeto, Mateu Espasa, María Dolores Quesada, Elisenda Miró, Montserrat Olsina, Eduardo V. Padilla, Lorena Forqué, Jordi Gómez Cámara, Antonio Casabella, Jordí Niubó, Olga González-Moreno, Jun Hao Wang-Wang, Berta Fidalgo, Sílvia Capilla, Sonia Broner, Aida Ramírez Marinero, Judit Serra-Pladevall, X Clivillé, Carla Benjumea, Mar Olga Pérez, Carmen Janeth Mora, Ferrán Martínez Navarro, Cristina Muñoz, J.C. de la Fuente, Araceli González, Percy Juan Ayala, Clàudia Martinez Miralles, Alba Bellés Bellés, Nuria Torrellas, Laura Solaz, Ester Sanfeliu, Jacobo Mendioroz, Pilar Ciruela, Marta Polo, Nieves Larrosa, Anna Llimós Fabregas, Naiana Pastrana-Batalla, Natàlia Roca, Mercè Herrero, Frederic Gómez, Isabel Pujol, Mayuli Armas, Miriam Campos, Ester Clapés, Joan López, Miquel Fantova Navarro, David Sánchez, Ariadna Hernández, Ester Picó, Inés Valle, Yuliya Poliakova, Alba Rivera, Eduard Anfruns, Gloria Trujillo, Maria Ángeles Dominguez, Rosa Costa, Rosalía Santos, Carles Alonso-Tarrés, Maria Navarro, Francesc Xavier Queralt, Elisabet Folch, Teresa Falgueras, Geraldine Quelis, José Stavola, Yannick Alan Hoyos, the Working Group of MRSC, Emma Padilla, Marc Garreta, Eric López, Victoria González, Manel Panisello, Pepa Pérez, Marta Albaiges, Jesús Trejo
article en

Abstract

Neisseria gonorrhoeae (NG) remains a major cause of sexually transmitted infections (STIs) in Europe. Increasing antimicrobial resistance (AMR) threatens treatments’ effectiveness and complicates control efforts. Continuous regional surveillance is essential to detect emerging trends and inform public health action. To describe NG epidemiology and AMR trends in Catalonia during 2022–2023, and identify associated resistance risk factors. Retrospective analysis of laboratory-confirmed NG cases reported to the Microbiological Reporting System of Catalonia and the STI Registry. Antimicrobial susceptibility testing (AST) was performed for seven antibiotics. Descriptive analysis and logistic regression were used to assess associations between AMR and demographic and clinical variables, including age, sex, sexual orientation and gender identity (SOGI) and anatomical site of infection. 23,968 NG cases were reported, representing an 18.9% increase in incidence from 2022 to 2023. Culture was performed in 5,158 cases, AST results were available for 4,709 isolates. Resistance was highest for ciprofloxacin (71.4%) and tetracycline (48.9%), followed by azithromycin (20.3%) and penicillin (10.2%). Cefixime and ceftriaxone resistance was negligible. Azithromycin resistance was independently associated with homosexual orientation (adjusted odds ratio (aOR): 2.08) and anal infection (aOR: 1.41). Age ≥ 25 years was associated with resistance to ciprofloxacin, tetracycline, and penicillin. High NG incidence and substantial resistance to older antibiotics, together with notable azithromycin resistance, underscore the need for sustained AMR surveillance, particularly among men who have sex with men (MSM) and in anal infections. Strengthening culture-based AMR surveillance, extragenital screening and targeted prevention strategies are essential to preserve effective treatment options.

European Journal of Clinical Microbiology & Infectious Diseases
Instituto de Salud Carlos III (ES), Centro de Investigación Biomédica en Red (ES), Agència de Salut Pública de Catalunya (ES), Vall d'Hebron Hospital Universitari (ES), Badalona Serveis Assistencials (ES), Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol (ES), Hospital Universitari de Vic (ES), Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (ES)
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Reproductive tract infections research
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