Rapid communication Open Access
Like 0


We describe a multidrug-resistant urethritis case with ceftriaxone resistance and azithromycin intermediate resistance in a heterosexual man in Ireland, August 2018. Whole-genome sequencing showed that the isolate IR72 belongs to the internationally spreading multidrug-resistant ceftriaxone-resistant FC428 clade, initially described in Japan in 2015. IR72 was assigned MSLT ST1903, NG-MAST ST17842 and NG-STAR type 1133, including the ceftriaxone resistance-mediating 60.001. Global awareness of spreading ceftriaxone-resistant gonococcal strains that threaten recommended dual therapies is essential.


Article metrics loading...

Loading full text...

Full text loading...



  1. Nakayama S, Shimuta K, Furubayashi K, Kawahata T, Unemo M, Ohnishi M. New ceftriaxone- and multidrug-resistant Neisseria gonorrhoeae strain with a novel mosaic penA gene isolated in Japan. Antimicrob Agents Chemother. 2016;60(7):4339-41.  https://doi.org/10.1128/AAC.00504-16  PMID: 27067334 
  2. Lahra MM, Martin I, Demczuk W, Jennison AV, Lee KI, Nakayama SI, et al. Cooperative recognition of internationally disseminated ceftriaxone-resistant Neisseria gonorrhoeae strain. Emerg Infect Dis. 2018;24(4):735-40.  https://doi.org/10.3201/eid2404.171873  PMID: 29553335 
  3. Lefebvre B, Martin I, Demczuk W, Deshaies L, Michaud S, Labbé AC, et al. Ceftriaxone-Resistant Neisseria gonorrhoeae, Canada, 2017. Emerg Infect Dis. 2018;24(2):381-3.  https://doi.org/10.3201/eid2402.171756  PMID: 29131780 
  4. Terkelsen D, Tolstrup J, Johnsen CH, Lund O, Larsen HK, Worning P, et al. Multidrug-resistant Neisseria gonorrhoeae infection with ceftriaxone resistance and intermediate resistance to azithromycin, Denmark, 2017. Euro Surveill. 2017;22(42):1273.  https://doi.org/10.2807/1560-7917.ES.2017.22.42.17-00659  PMID: 29067905 
  5. Poncin T, Fouere S, Braille A, Camelena F, Agsous M, Bebear C, et al. Multidrug-resistant Neisseria gonorrhoeae failing treatment with ceftriaxone and doxycycline in France, November 2017. Euro Surveill. 2018;23(21):1800264.  https://doi.org/10.2807/1560-7917.ES.2018.23.21.1800264  PMID: 29845928 
  6. Hjelmevoll SO, Olsen ME, Ericson Sollid JU, Haaheim H, Unemo M, Skogen V. A fast real-time PCR method for sensitive and specific detection of the Neisseria gonorrhoeae porA pseudogene. J Mol Diagn. 2006;8(5):574-81.  https://doi.org/10.2353/jmoldx.2006.060024  PMID: 17065426 
  7. European Committee on Antimicrobial Susceptibility Testing (EUCAST). Basel: EUCAST; 2018. Available from: www.eucast.org
  8. Hodge W, Ciak J, Tramont EC. Simple method for detection of penicillinase-producing Neisseria gonorrhoeae. J Clin Microbiol. 1978;7(1):102-3. PMID: 415067 
  9. Jacobsson S, Golparian D, Cole M, Spiteri G, Martin I, Bergheim T, et al. WGS analysis and molecular resistance mechanisms of azithromycin-resistant (MIC >2 mg/L) Neisseria gonorrhoeae isolates in Europe from 2009 to 2014. J Antimicrob Chemother. 2016;71(11):3109-16.  https://doi.org/10.1093/jac/dkw279  PMID: 27432597 
  10. Ryan L, Golparian D, Fennelly N, Rose L, Walsh P, Lawlor B, et al. Antimicrobial resistance and molecular epidemiology using whole-genome sequencing of Neisseria gonorrhoeae in Ireland, 2014-2016: focus on extended-spectrum cephalosporins and azithromycin. Eur J Clin Microbiol Infect Dis. 2018;37(9):1661-72.  https://doi.org/10.1007/s10096-018-3296-5  PMID: 29882175 
  11. Eyre DW, Sanderson ND, Lord E, Regisford-Reimmer N, Chau K, Barker L, et al. Gonorrhoea treatment failure caused by a Neisseria gonorrhoeae strain with combined ceftriaxone and high-level azithromycin resistance, England, February 2018. Euro Surveill. 2018;23(27):1800323.  https://doi.org/10.2807/1560-7917.ES.2018.23.27.1800323  PMID: 29991383 
  12. Igawa G, Yamagishi Y, Lee KI, Dorin M, Shimuta K, Suematsu H, et al. Neisseria cinerea with high ceftriaxone MIC is a source of ceftriaxone and cefixime resistance-mediating penA sequences in Neisseria gonorrhoeae. Antimicrob Agents Chemother. 2018;62(3):e02069-17.  https://doi.org/10.1128/AAC.02069-17  PMID: 29311079 
  13. Unemo M, Shafer WM. Antimicrobial resistance in Neisseria gonorrhoeae in the 21st century: past, evolution, and future. Clin Microbiol Rev. 2014;27(3):587-613.  https://doi.org/10.1128/CMR.00010-14  PMID: 24982323 
  14. Wi T, Lahra MM, Ndowa F, Bala M, Dillon JR, Ramon-Pardo P, et al. Antimicrobial resistance in Neisseria gonorrhoeae: Global surveillance and a call for international collaborative action. PLoS Med. 2017;14(7):e1002344.  https://doi.org/10.1371/journal.pmed.1002344  PMID: 28686231 
  15. Cole MJ, Spiteri G, Jacobsson S, Pitt R, Grigorjev V, Unemo M, Euro-GASP Network. Is the tide turning again for cephalosporin resistance in Neisseria gonorrhoeae in Europe? Results from the 2013 European surveillance. BMC Infect Dis. 2015;15(1):321.  https://doi.org/10.1186/s12879-015-1013-x  PMID: 26259560 
  16. Kirkcaldy RD, Harvey A, Papp JR, Del Rio C, Soge OO, Holmes KK, et al. Neisseria gonorrhoeae antimicrobial susceptibility surveillance – The Gonococcal Isolate Surveillance Project, 27 sites, United States, 2014. MMWR Surveill Summ. 2016;65(7):1-19.  https://doi.org/10.15585/mmwr.ss6507a1  PMID: 27414503 
  17. Whiley DM, Jennison A, Pearson J, Lahra MM. Genetic characterisation of Neisseria gonorrhoeae resistant to both ceftriaxone and azithromycin. Lancet Infect Dis. 2018;18(7):717-8.  https://doi.org/10.1016/S1473-3099(18)30340-2  PMID: 29976521 
  18. Bignell C, Unemo M, European STI Guidelines Editorial Board. 2012 European guideline on the diagnosis and treatment of gonorrhoea in adults. Int J STD AIDS. 2013;24(2):85-92.  https://doi.org/10.1177/0956462412472837  PMID: 24400344 

Data & Media loading...

Submit comment
Comment moderation successfully completed
This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error