Gonococcus Reference Laboratory

The Gonococcus Reference Laboratory at Statens Serum Institut collects bacteriological surveillance data for national health authorities and international health organizations.

The reference function is part of the Bacteria, Parasites & Fungi in the Infectious Disease Preparedness.

The genus Neisseria comprises about 20 species, two of which cause important diseases. 

  • Neisseria gonorrhoeae (gonococci) causes gonorrhoea. The demonstration of gonococci in clinical specimens is always considered pathologic. 
  • Neisseria meningitidis (meningococci) may cause invasive disease, in particular meningitis and septicaemia but asymptomatic (and unharmful) throat carriage is quite frequent. The occurrence and characteristics of both species are monitored by the Nesseria and Streptococcus Reference Laboratory. 
  • Other Neisseria species are rarely pathogenic in humans and only under special circumstances. 
  • All analytical methods in the Reference Laboratory are DANAK accredited according to the ISO/IEC 17025 standard. 

Purpose

  • Surveillance of laboratory verified gonococci in Denmark. 
  • Surveillance of antimicrobial resistance in gonococci. 
  • Molecular typing of gonococci. 

Surveillance of gonococci in Denmark

The surveillance of gonorrhoea in Denmark is based on two reporting systems:

  • In the laboratory reporting system all departments of clinical microbiology submit gonococcus strains isolated from clinical specimens as well as certain data about the patient and the specimen. 
  • In the mandatory clinical epidemiological reporting system the physician who treats the patient submits information to the Infectious Disease Epidemiology & Prevention about sexual orientation, country of infection, mode of infection etc. 

Surveillance of antimicrobial resistance in gonococci

All submitted isolates are tested for beta-lactamase production and susceptibility to azithromycin, ceftriaxon, and ciprofloxacin measurement of MIC (minimum inhibitory concentration) using Etest. This panel may be expanded upon request to include e.g. gentamicin. The panel is also expanded when a subset of isolates are examined for the annual participation in Euro-GASP.

Characterisation of gonococci

Typing of the submitted gonococcus isolates is not routinely performed. If relevant, strains can be characterized by whole-genome sequencing including NG-MAST (Neisseria gonorrhoeae Multi Antigen Sequence Typing and SNP-analysis (single nucleotid polymorphism)).

Publication of the result of surveillance of gonococci

The surveillance data are published nationally and internationally. 

Nationally

A yearly report is published in EPI-NEWS and in DANMAP

Internationally 

Data on gonorrhoea are reported to EU’s database TESSy (The European Surveillance System) in ECDC

Once a year, approximately 110 consecutive isolates from unique cases of gonorrhoea are tested for susceptibility to the standard panel of antibiotics (azithromycin, ceftriaxon, and ciprofloxacin), and in addition to cefixime, gentamicjn  and spectinomycin, These data form part of Euro-GASP (European Gonococcal Antimicrobial Surveillance Programme)

Projects

EU project: The Reference Laboratory participates in laboratory projects in cooperation with Public Health England, London, and Department of Clinical Microbiology, University Hospital, Örebro, Sweden.

Participation in EQA (External Quality Assessment) programmes

The reference laboratory receives spiked specimens from UK-NEQAS and from Labquality in order to assess the quality of culture based diagnosis and susceptibility testing of gonococci. In addition, we cooperate with Public Health England, London, regarding quality assessment of the susceptibility testing of gonococci.