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We describe detection in the United Kingdom (UK) of the drug-resistant FC428 clone, with ceftriaxone resistance and intermediate azithromycin resistance. Two female patients developed infection following contact with UK-resident men from the same sexual network linked to travel to Ibiza, Spain. One case failed treatment with ceftriaxone, and azithromycin and gentamicin, before successful treatment with ertapenem. Both isolates had indistinguishable whole-genome sequences. Urgent action is essential to contain this drug-resistant strain.


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  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. Yahara K, Nakayama S-I, Shimuta K, Lee KI, Morita M, Kawahata T, et al. Genomic surveillance of Neisseria gonorrhoeae to investigate the distribution and evolution of antimicrobial-resistance determinants and lineages. Microb Genom. 2018;4(8): Epub ahead of print.  https://doi.org/10.1099/mgen.0.000205  PMID: 30063202 
  3. 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).  https://doi.org/10.3201/eid2404.171873  PMID: 29553335 
  4. 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 
  5. 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 
  6. 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):e1002344.  https://doi.org/10.2807/1560-7917.ES.2018.23.21.1800264  PMID: 29845928 
  7. Golparian D, Rose L, Lynam A, Mohamed A, Bercot B, Ohnishi M, et al. Multidrug-resistant Neisseria gonorrhoeae isolate, belonging to the internationally spreading Japanese FC428 clone, with ceftriaxone resistance and intermediate resistance to azithromycin, Ireland, August 2018. Euro Surveill. 2018;23(47):4339.  https://doi.org/10.2807/1560-7917.ES.2018.23.47.1800617  PMID: 30482267 
  8. Marrazzo JM, Apicella MA. 214 - Neisseria gonorrhoeae (Gonorrhea). In: Blaser JEBDJ, ed. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases (8th Edition). Philadelphia: Churchill Livingstone 2015: pp 2446–62.
  9. European Committee on Antimicrobial Susceptibility Testing (EUCAST). Breakpoint tables for interpretation of MICs and zone diameters. Version 8.1. EUCAST; 2018. Available from: http://www.eucast.org/fileadmin/src/media/PDFs/EUCAST_files/Breakpoint_tables/v_8.1_Breakpoint_Tables.pdf
  10. 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):364.  https://doi.org/10.2807/1560-7917.ES.2018.23.27.1800323  PMID: 29991383 
  11. Guindon S, Dufayard J-F, Lefort V, Anisimova M, Hordijk W, Gascuel O. New algorithms and methods to estimate maximum-likelihood phylogenies: assessing the performance of PhyML 3.0. Syst Biol. 2010;59(3):307-21.  https://doi.org/10.1093/sysbio/syq010  PMID: 20525638 
  12. Didelot X, Wilson DJ. ClonalFrameML: efficient inference of recombination in whole bacterial genomes. PLOS Comput Biol. 2015;11(2):e1004041.  https://doi.org/10.1371/journal.pcbi.1004041  PMID: 25675341 
  13. Unemo M, Golparian D, Nicholas R, Ohnishi M, Gallay A, Sednaoui P. High-level cefixime- and ceftriaxone-resistant Neisseria gonorrhoeae in France: novel penA mosaic allele in a successful international clone causes treatment failure. Antimicrob Agents Chemother. 2012;56(3):1273-80.  https://doi.org/10.1128/AAC.05760-11  PMID: 22155830 
  14. Lahra MM, Ryder N, Whiley DM. A new multidrug-resistant strain of Neisseria gonorrhoeae in Australia. N Engl J Med. 2014;371(19):1850-1.  https://doi.org/10.1056/NEJMc1408109  PMID: 25372111 
  15. Ohnishi M, Golparian D, Shimuta K, Saika T, Hoshina S, Iwasaku K, et al. Is Neisseria gonorrhoeae initiating a future era of untreatable gonorrhea?: detailed characterization of the first strain with high-level resistance to ceftriaxone. Antimicrob Agents Chemother. 2011;55(7):3538-45.  https://doi.org/10.1128/AAC.00325-11  PMID: 21576437 
  16. Eyre DW, De Silva D, Cole K, Peters J, Cole MJ, Grad YH, et al. WGS to predict antibiotic MICs for Neisseria gonorrhoeae. J Antimicrob Chemother. 2017;72(7):1937-47.  https://doi.org/10.1093/jac/dkx067  PMID: 28333355 
  17. Suchard MA, Lemey P, Baele G, Ayres DL, Drummond AJ, Rambaut A. Bayesian phylogenetic and phylodynamic data integration using BEAST 1.10. Virus Evol. 2018;4(1):vey016.  https://doi.org/10.1093/ve/vey016  PMID: 29942656 
  18. De Silva D, Peters J, Cole K, Cole MJ, Cresswell F, Dean G, et al. Whole-genome sequencing to determine transmission of Neisseria gonorrhoeae: an observational study. Lancet Infect Dis. 2016;16(11):1295-303.  https://doi.org/10.1016/S1473-3099(16)30157-8  PMID: 27427203 
  19. Weston EJ, Wi T, Papp J. Strengthening global surveillance for antimicrobial drug–resistant Neisseria gonorrhoeae through the enhanced gonococcal antimicrobial surveillance program. Emerg Infect Dis. 2017;23(13).  https://doi.org/10.3201/eid2313.170443  PMID: 29155673 
  20. Handsfield HH, Lipman TO, Harnisch JP, Tronca E, Holmes KK. Asymptomatic gonorrhea in men. Diagnosis, natural course, prevalence and significance. N Engl J Med. 1974;290(3):117-23.  https://doi.org/10.1056/NEJM197401172900301  PMID: 4202519 
  21. Taylor SN, Marrazzo J, Batteiger BE, Hook EW 3rd, Seña AC, Long J, et al. Single-dose zoliflodacin (etx0914) for treatment of urogenital gonorrhea. N Engl J Med. 2018;379(19):1835-45.  https://doi.org/10.1056/NEJMoa1706988  PMID: 30403954 
  22. Suay-García B, Pérez-Gracia MT. Future prospects for Neisseria gonorrhoeae treatment. Antibiotics (Basel). 2018;7(2):E49.  https://doi.org/10.3390/antibiotics7020049  PMID: 29914071 
  23. Whiley DM, Mhango L, Jennison AV, Nimmo G, Lahra MM. Direct detection of penA gene associated with ceftriaxone-resistant Neisseria gonorrhoeae FC428 strain by using PCR. Emerg Infect Dis. 2018;24(8):1573-5.  https://doi.org/10.3201/eid2408.180295  PMID: 30016236 

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