Rapid communication Open Access
Like 0


We report two extensively drug-resistant (XDR) (NG) isolates combining high-level resistance to azithromycin and resistance to ceftriaxone, obtained in France from two heterosexual patients, one of whom returned from Cambodia. Whole genome sequencing identified MLST ST16406, the mosaic -60.001 which caused ceftriaxone resistance in the internationally spreading FC428 clone, and the A2059G mutation in the 23S rRNA gene. The NG isolates F93 and F94 were related to XDR isolates detected in Austria and the United Kingdom in 2022.


Article metrics loading...

Loading full text...

Full text loading...



  1. Tapsall JW, Ndowa F, Lewis DA, Unemo M. Meeting the public health challenge of multidrug- and extensively drug-resistant Neisseria gonorrhoeae. Expert Rev Anti Infect Ther. 2009;7(7):821-34.  https://doi.org/10.1586/eri.09.63  PMID: 19735224 
  2. Cole MJ, Day M, Jacobsson S, Amato-Gauci AJ, Spiteri G, Unemo M, et al. The European response to control and manage multi- and extensively drug-resistant Neisseria gonorrhoeae. Euro Surveill. 2022;27(18):2100611.  https://doi.org/10.2807/1560-7917.ES.2022.27.18.2100611  PMID: 35514307 
  3. Day M, Pitt R, Mody N, Saunders J, Rai R, Nori A, et al. Detection of 10 cases of ceftriaxone-resistant Neisseria gonorrhoeae in the United Kingdom, December 2021 to June 2022. Euro Surveill. 2022;27(46):2200803.  https://doi.org/10.2807/1560-7917.ES.2022.27.46.2200803  PMID: 36398578 
  4. Pleininger S, Indra A, Golparian D, Heger F, Schindler S, Jacobsson S, et al. Extensively drug-resistant (XDR) Neisseria gonorrhoeae causing possible gonorrhoea treatment failure with ceftriaxone plus azithromycin in Austria, April 2022. Euro Surveill. 2022;27(24):1-5. https://doi.org/10.2807/1560-7917.ES.2022.27.24.2200455  PMID: 35713023 
  5. Brun J-L, Castan B, de Barbeyrac B, Cazanave C, Charvériat A, Faure K, et al. Pelvic inflammatory diseases: Updated French guidelines. J Gynecol Obstet Hum Reprod. 2020;49(5):101714.  https://doi.org/10.1016/j.jogoh.2020.101714  PMID: 32087306 
  6. Fouéré S, Cazanave C, Hélary M, Dupin N, Tattevin P, Bébéar C, et al. Update on French recommendations for the treatment of uncomplicated Neisseria gonorrhoeae infections. Int J STD AIDS. 2021;32(11):1081-3.  https://doi.org/10.1177/09564624211023025  PMID: 34125636 
  7. Han Y, Yin Y, Dai X, Chen S, Yang L, Zhu B, et al. Widespread use of high-dose ceftriaxone therapy for uncomplicated gonorrhea without reported ceftriaxone treatment failure: results from 5 years of multicenter surveillance data in China. Clin Infect Dis. 2020;70(1):99-105.  https://doi.org/10.1093/cid/ciz170  PMID: 30838398 
  8. European Committee on Antimicrobial Susceptibility Testing (EUCAST). Breakpoint tables for interpretation of MICs and zone diameters. Version 13.0. Växjö: EUCAST; 2023. Available from: https://www.eucast.org
  9. 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):2-4.  https://doi.org/10.2807/1560-7917.ES.2018.23.21.1800264  PMID: 29845928 
  10. Poncin T, Merimeche M, Braille A, Mainardis M, Bebear C, Jacquier H, et al. Two cases of multidrug-resistant Neisseria gonorrhoeae related to travel in south-eastern Asia, France, June 2019. Euro Surveill. 2019;24(36):1-4.  https://doi.org/10.2807/1560-7917.ES.2019.24.36.1900528  PMID: 31507264 
  11. Berçot B, Caméléna F, Mérimèche M, Jacobsson S, Sbaa G, Mainardis M, et al. Ceftriaxone-resistant, multidrug-resistant Neisseria gonorrhoeae with a novel mosaic penA-237.001 gene, France, June 2022. Euro Surveill. 2022;27(50):1900528.  https://doi.org/10.2807/1560-7917.ES.2022.27.50.2200899  PMID: 36695466 
  12. 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 
  13. 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 
  14. 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 
  15. Treangen TJ, Ondov BD, Koren S, Phillippy AM. The Harvest suite for rapid core-genome alignment and visualization of thousands of intraspecific microbial genomes. Genome Biol. 2014;15(11):524.  https://doi.org/10.1186/s13059-014-0524-x  PMID: 25410596 
  16. 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 
  17. 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 
  18. Chisholm SA, Dave J, Ison CA. High-level azithromycin resistance occurs in Neisseria gonorrhoeae as a result of a single point mutation in the 23S rRNA genes. Antimicrob Agents Chemother. 2010;54(9):3812-6.  https://doi.org/10.1128/AAC.00309-10  PMID: 20585125 
  19. Jennison AV, Whiley D, Lahra MM, Graham RM, Cole MJ, Hughes G, et al. Genetic relatedness of ceftriaxone-resistant and high-level azithromycin resistant Neisseria gonorrhoeae cases, United Kingdom and Australia, February to April 2018. Euro Surveill. 2019;24(8):1900118.  https://doi.org/10.2807/1560-7917.ES.2019.24.8.1900118  PMID: 30808445 
  20. Tang Y, Liu X, Chen W, Luo X, Zhuang P, Yang Y, et al. Antimicrobial resistance profiling and genome analysis of the penA-60.001 Neisseria gonorrhoeae clinical isolates in China in 2021. J Infect Dis. 2023;5-6:jiad258.  https://doi.org/10.1093/infdis/jiad258  PMID: 37462263 
  21. Ouk V, Pham CD, Wi T, van Hal SJ, Lahra MM, EGASP Cambodia working group. The Enhanced Gonococcal Surveillance Programme, Cambodia. Lancet Infect Dis. 2023;23(9):e332-3.  https://doi.org/10.1016/S1473-3099(23)00479-6  PMID: 37549683 

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