Report on Gonococcal Antimicrobial Resistance in Europe and Implications for Sustainable Development Goal 3

Introduction: A Public Health Challenge to SDG 3

Recent surveillance data from the European Centre for Disease Prevention and Control (ECDC) indicates a significant challenge to achieving Sustainable Development Goal 3 (Good Health and Well-being), specifically Target 3.3, which aims to end the epidemics of communicable diseases. The data reveals high levels of tetracycline resistance in gonococcal isolates across Europe, undermining the potential efficacy of doxycycline post-exposure prophylaxis (doxy-PEP) as a public health intervention to reduce the incidence of this sexually transmitted infection.

Methodology: A Collaborative Surveillance Effort (SDG 17)

In alignment with SDG 17 (Partnerships for the Goals), the European Gonococcal Antimicrobial Surveillance Programme (Euro-GASP) conducted its annual data collection from September to November 2023. This collaborative effort involved laboratories from 24 European Union/European Economic Area (EU/EEA) member states.

• A total of 5,269 isolates were submitted to the European Surveillance System.
• Of these, 3,184 were included in the final analysis.
• Isolates were tested for susceptibility to key antimicrobials and for resistance markers to inform treatment guidelines and public health strategies.

Key Findings: Demographics and Resistance Patterns

The analysis provides critical insights into the populations affected, highlighting the need for targeted interventions to reduce health inequalities as per SDG 10 (Reduced Inequalities).

Patient Demographics

• Gender: 82.6% of specimens were from males.
• Age: The median patient age was 30 years (range:
• Key Populations: Among patients with known transmission data, 46.6% were men who have sex with men (MSM).
• Co-infections: 9.7% of patients with a known HIV status were HIV-positive, with this group being predominantly composed of MSM (97.6%).

Antimicrobial Susceptibility

1. Tetracycline Resistance: A high level of resistance was observed, with 58.4% of all isolates demonstrating resistance to tetracycline. This finding suggests that doxy-PEP is unlikely to be an effective strategy for reducing gonorrhea incidence across the EU/EEA.
2. Treatment Recommendations: In response to resistance patterns, the European treatment guideline emphasizes the use of effective therapies to ensure patient health and prevent further transmission, contributing to SDG 3. The recommended regimens are:
   • High-dose ceftriaxone plus azithromycin dual therapy.
   • High-dose ceftriaxone monotherapy.

Conclusion: Upholding SDG 3 Through Vigilant Surveillance and Treatment

The high prevalence of tetracycline resistance in Neisseria gonorrhoeae across Europe poses a direct threat to public health and the achievement of SDG 3. The findings underscore the limited utility of doxy-PEP in this region. Continued antimicrobial resistance surveillance, as demonstrated by the Euro-GASP initiative, is essential for strengthening national and global health security (Target 3.d). Adherence to updated, evidence-based treatment guidelines is critical to effectively manage infections, combat the spread of antimicrobial resistance, and continue progress toward ending the epidemic of sexually transmitted infections.

Analysis of Sustainable Development Goals in the Article

1. Which SDGs are addressed or connected to the issues highlighted in the article?

   • SDG 3: Good Health and Well-being

     The entire article is centered on public health, specifically addressing the challenge of a communicable, sexually transmitted infection (gonorrhea). It discusses disease surveillance, antimicrobial resistance, and treatment guidelines, all of which are core components of ensuring healthy lives and promoting well-being for all at all ages.

2. What specific targets under those SDGs can be identified based on the article’s content?

   • Target 3.3: End the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases and combat hepatitis, water-borne diseases and other communicable diseases.

     Gonorrhea is a communicable disease. The article’s focus on surveillance, resistance patterns, and effective treatment directly contributes to the global effort to combat such diseases. The mention of HIV co-infection (“9.7% of 31.2% patients with known HIV status had HIV”) also links the issue to the broader goal of ending the AIDS epidemic.

   • Target 3.d: Strengthen the capacity of all countries, in particular developing countries, for early warning, risk reduction and management of national and global health risks.

     The article describes the European Gonococcal Antimicrobial Surveillance Programme (Euro-GASP), a multinational effort to monitor antimicrobial resistance. This program is a clear example of a system for early warning and management of a significant global health risk—the spread of drug-resistant infections. The data collected, such as the high tetracycline resistance, informs public health policy and risk reduction strategies.

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

   • Prevalence of Antimicrobial Resistance

     This is a direct indicator for Target 3.d. The article explicitly states a key finding from the surveillance: a “high level of tetracycline resistance (58.4% of isolates).” Monitoring this percentage over time is a direct way to measure the management of the health risk associated with antimicrobial resistance.

   • Incidence and Prevalence of Communicable Diseases

     This is an indicator for Target 3.3. While the article does not provide a national incidence rate, it offers data points that help characterize the epidemic. For instance, it notes that among patients with data on prior diagnoses, “33.3% had previously been infected,” suggesting a high rate of transmission or reinfection. It also provides demographic data on affected populations (e.g., “46.6% were men who have sex with men (MSM)”), which is crucial for tracking and combating the disease.

   • Co-infection Rates with Other Diseases

     This is an indicator related to Target 3.3. The article mentions that “9.7% of 31.2% patients with known HIV status had HIV.” Tracking the co-infection rate of gonorrhea and HIV is important for understanding the interconnected nature of these epidemics and measuring the success of integrated health interventions.

4. Create a table with three columns titled ‘SDGs, Targets and Indicators” to present the findings from analyzing the article.

   SDGs	Targets	Indicators
   SDG 3: Good Health and Well-being	3.3: By 2030, end the epidemics of… other communicable diseases.	Proportion of patients with previous infections (33.3% of those with data). Prevalence of co-infections (e.g., 9.7% of patients with known status had HIV). Demographic breakdown of infected populations (e.g., MSM, heterosexual males, females).
   SDG 3: Good Health and Well-being	3.d: Strengthen the capacity of all countries… for early warning, risk reduction and management of national and global health risks.	Existence of a regional surveillance program (The European Gonococcal Antimicrobial Surveillance Programme – Euro-GASP). Percentage of antimicrobial resistance in isolates (e.g., 58.4% resistance to tetracycline).

Source: cidrap.umn.edu