Phenotypic and genotypic characterization of Neisseria gonorrhoeae isolates from Ethiopia, 2021 to 2023

Abstract Objectives Antimicrobial resistance (AMR) in Neisseria gonorrhoeae is increasing globally, but some regions remain understudied. This study aimed to investigate the AMR phenotypes and genotypes of N. gonorrhoeae isolates from Bahir Dar, Ethiopia, and their phylogenetic relationship to global isolates. Methods Endocervical and urethral swabs were collected from symptomatic patients at sexually transmitted infection (STI) clinics from September 2021 to April 2023. The identified N. gonorrhoeae isolates (n = 70) were subjected to AMR phenotyping and WGS. We generated a recombination-corrected phylogeny with 724 global representative isolates and used phylodynamics to estimate the introduction times of isolates into Bahir Dar. Results All isolates were resistant to ciprofloxacin and tetracycline but susceptible to ceftriaxone, cefixime, azithromycin, and spectinomycin (100% susceptibility); 67 (95.7%) were resistant to penicillin. WGS identified 14 MLSTs, with ST-1587 (54.3%) the dominant sequence type. AMR determinants correlated with phenotypic findings for all antimicrobials. The phylogenetic analysis suggested at least nine introductions of N. gonorrhoeae into Bahir Dar. The ST-1587 isolates were introduced recently, showing close genetic ties to global isolates sampled in 2018–2019 from Asia, Europe, North America, and Oceania. ST-7827 displayed greater genetic divergence from global isolates. Conclusions This study presents WGS of N. gonorrhoeae isolates from Ethiopia, uncovering diverse sequence types and multidrug resistance. These findings underscore the need for routine genomic surveillance, improved antimicrobial stewardship, and targeted public health interventions to combat the spread of AMR and improve STI management in Ethiopia.