GRASP (Gonococcal Resistance to Antimcrobials Surveillance Programme) is a national sentinel surveillance programme which has monitored trends and drifts in susceptibility in gonococcal isolates since 2000. It collects isolates from consecutive patients attending a network of 26 genitourinary medicine (GUM) clinics that give regional representation in England and Wales.
GRASP informed a change in national guidelines in 2002 from ciprofloxacin, the antimicrobial agent of choice, to the third generation cephalosporins, cefixime and ceftriaxone. These highly effective agents have been used in the UK for almost a decade with considerable success. The GRASP report in 2009 gave worrying indications that there was a drift towards decreased susceptibility to these agents, particularly for cefixime, the oral agent that has been most widely used. However, the true definition of resistance and its relationship to the in vitro susceptibility data and the dosage given were unknown because of the lack of treatment failures. In 2011, the first reports of treatment failures began to emerge both in England and in other European countries, suggesting that history is repeating itself and the gonococcus is posing a new challenge to maintain gonorrhoea as a treatable infection.
Gonorrhoea remains the second most common sexually transmitted infection in England and Wales with 16,531 cases reported in 2010, a 3% increase on 2009. However, this is an era of change with molecular diagnosis becoming widely used and detecting more infections in extra-genital sites than was ever possible by conventional isolation techniques. This presents challenges for GRASP in continuing to collect and test a representative sample of isolates that can inform clinical guidelines.