Increased Diversity and Introduction of Multidrug-Resistant Strains of Neisseria gonorrhoeae Following Cessation of COVID-19 Pandemic–Related Travel Restrictions: An Observational Genomic Epidemiologic Study

BACKGROUND: National and international travel drives the spread of antimicrobial resistance in high-priority pathogens, including Neisseria gonorrhoeae. Border closures and travel restrictions in response to the COVID-19 pandemic had wide-reaching impacts on infectious disease epidemiology, including the transmission and genomic diversity of N gonorrhoeae. However, less is known about N gonorrhoeae population structures in the years following the lifting of pandemic restrictions. METHODS: This study analyzed N gonorrhoeae genomic data collected for routine public health surveillance in South Australia, Australia, and contextual sequences from Victoria, Australia, before and after the cessation of COVID-19 interstate and international travel restrictions. RESULTS: N gonorrhoeae was highly clonal during periods with restricted travel, and genomic diversity markedly increased after restrictions were removed, possibly driven by increased transmission and the introduction of new strains. CONCLUSIONS: Routine genomic surveillance is an important public health tool for the monitoring of N gonorrhoeae, especially the introduction and spread of antimicrobial resistant strains.