The frequency of mutations in thepenA,mtrR,gyrA andparC genes ofNeisseria gonorrhoeae, the presence oftetM gene and antibiotic resistance/susceptibility: a systematic review and meta-analyses

Abstract

ABSTRACTSexually transmitted infections (STIs) are a major global public health problem and among the most common infectious diseases. Gonorrhoea is an STI that affects only humans, caused by the bacteriumNeisseria gonorrhoeae. In 2016, the WHO estimated that there were 86.9 million cases of gonorrhoea worldwide. Gonorrhoea is currently one of the most important STIs due to the increased spread and emergence of multiresistant strains. The main goal of this study was to analyse the relationship between resistance or decreased susceptibility to antibiotics inN. gonorrhoeaeand the presence of mutations in the genespenA,mtrR,tetM,gyrA andparC. Therefore, we conducted a systematic review following the PRISMA guidelines. We selected 19 studies for thepenA gene, 23 forgyrA andparC, 18 formtrR, and 12 fortetM using the Science Direct and PubMed databases. The included studies addressed susceptibility and resistance to antibiotics and mutations in the selected genes. Then, 21 different meta-analyses of the studies were performed. A meta-analysis was conducted when two or more studies were found for the same gene and the same antibiotic. Meta-analyses of isolates resistant to penicillin, cefixime, and ceftriaxone showed that more than 50% of the isolates had mutations in the genespenA andmtrR. Meanwhile, more than 50% of azithromycin-resistant isolates had mutations in themtrR gene, while more than 50% of the isolates resistant and intermediate-resistant to ciprofloxacin had mutations ingyrA. Moreover, less than 50% of isolates with intermediate resistance to ciprofloxacin had mutations inparC. The plasmid containing thetetM gene was found in more than 50% of tetracycline-resistant isolates. Infection monitoring and genetic studies are important to control the spread, which can improve the quality of life of infected individuals and lessen the financial burden on public healthcare systems.