1887
  1. Home
  2. Eurosurveillance
  3. Volume 31, Issue 21, 28/May/2026
  4. Article
Rapid communication Open Access
Like 0
Download

SDG 3: Antimicrobial resistance

Abstract

In early 2026 in Croatia, a male heterosexual patient of Croatian origin was diagnosed with extensively drug-resistant (XDR) gonorrhoea after unprotected vaginal intercourse with a Croatian female. The HR027 isolate (genomic lineage B, MLST sequence type (ST)9903) exhibited high-level azithromycin, ceftriaxone, cefixime, benzylpenicillin, ciprofloxacin and tetracycline resistance. It had the mosaic -60.001 allele, and A2045G mutations in 23S rRNA. A single dose of ceftriaxone 2 g administered intravenously cured the infection. HR027 showed zoliflodacin and gepotidacin wild-type minimum inhibitory concentrations.

© Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.
Loading

Article metrics loading...

/content/10.2807/1560-7917.ES.2026.31.21.2600422
2026-05-28
2026-06-10
/content/10.2807/1560-7917.ES.2026.31.21.2600422
Loading
Loading full text...

Full text loading...

/deliver/fulltext/eurosurveillance/31/21/eurosurv-31-21-1.html?itemId=/content/10.2807/1560-7917.ES.2026.31.21.2600422&mimeType=html&fmt=ahah

References

  1. Unemo M, Ross J, Serwin AB, Gomberg M, Cusini M, Jensen JS. 2020 European guideline for the diagnosis and treatment of gonorrhoea in adults. Int J STD AIDS. 2020. 956462420949126.  https://doi.org/10.1177/0956462420949126  PMID: 29991383 
  2. 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 
  3. Cole MJ, Day M, Jacobsson S, Amato-Gauci AJ, Spiteri G, Unemo M, the European Gonorrhoea Response Plan Group, European Gonorrhoea Response Plan Group. 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 
  4. Maubaret C, Caméléna F, Mrimèche M, Braille A, Liberge M, Mainardis M, et al. Two cases of extensively drug-resistant (XDR) Neisseria gonorrhoeae infection combining ceftriaxone-resistance and high-level azithromycin resistance, France, November 2022 and May 2023. Euro Surveill. 2023;28(37):2300456.  https://doi.org/10.2807/1560-7917.ES.2023.28.37.2300456  PMID: 37707979 
  5. 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):2200455.  https://doi.org/10.2807/1560-7917.ES.2022.27.24.2200455  PMID: 35713023 
  6. Selb R, Tlapák H, Klaper K, Buder S, Jansen K, Heuer D. Autochthonous transmission of extensively drug-resistant Neisseria gonorrhoeae in Germany, 2025. Euro Surveill. 2025;30(40):2500738.  https://doi.org/10.2807/1560-7917.ES.2025.30.40.2500738  PMID: 41070451 
  7. Caméléna F, Mérimèche M, Brousseau J, Mainardis M, Verger P, Le Risbé C, et al. Emergence of extensively drug-resistant Neisseria gonorrhoeae, France, 2023. Emerg Infect Dis. 2024;30(9):1903-6.  https://doi.org/10.3201/eid3009.240557  PMID: 39084693 
  8. Ouk V, Heng LS, Virak M, Deng S, Lahra MM, Frankson R, et al. , EGASP Cambodia Working Group. High prevalence of ceftriaxone-resistant and XDR Neisseria gonorrhoeae in several cities of Cambodia, 2022-23: WHO Enhanced Gonococcal Antimicrobial Surveillance Programme (EGASP). JAC Antimicrob Resist. 2024;6(2):dlae053.  https://doi.org/10.1093/jacamr/dlae053  PMID: 38577702 
  9. Croatian Parliament. Act on the Protection of the Population from Infectious Diseases. Official Gazette (Narodne novine) 79/07, 113/08, 43/09, 130/17, 114/18, 47/20, 134/20, 143/21. [Accessed 27 May 2026]. Available from: Zakon o zaštiti pučanstva od zaraznih bolesti
  10. Croatian Institute of Public Health (HZJZ). Department for Communicable Disease Surveillance and Registry. Zagreb: Croatian Institute of Public Health. [Accessed 27 May 2026]. Available from: https://www.hzjz.hr/sluzba-epidemiologija-zarazne-bolesti/odjel-za-pracenje-zaraznih-bolesti-s-registrom-zaraznih-bolesti/?utm_source=chatgpt.com
  11. European Committee on Antimicrobial Susceptibility Testing. (EUCAST; V16.0). Clinical Breakpoint Tables. Version 16.0. Växjö: EUCAST; 2026. [Accessed on 27 April 2026]. Available from: https://www.eucast.org/bacteria/clinical-breakpoints-and-interpretation/clinical-breakpoint-tables/
  12. Luckey A, Balasegaram M, Barbee LA, Batteiger TA, Broadhurst H, Cohen SE, et al. , Zoliflodacin Phase 3 Study Group. Zoliflodacin versus ceftriaxone plus azithromycin for treatment of uncomplicated urogenital gonorrhoea: an international, randomised, controlled, open-label, phase 3, non-inferiority clinical trial. Lancet. 2026;407(10524):147-60.  https://doi.org/10.1016/S0140-6736(25)01953-1  PMID: 41391465 
  13. Unemo M, Golparian D, Elango V, Bettiol E, Piddock LJV, Srinivasan S, et al. Microbiological analysis and whole-genome sequencing of Neisseria gonorrhoeae from the microbiological failures in the international, zoliflodacin, phase 3, clinical trial for treatment of uncomplicated urogenital gonorrhoea: a retrospective, genomic, observational study. Lancet Microbe. 2026;7(2):101270.  https://doi.org/10.1016/j.lanmic.2025.101270  PMID: 41655579 
  14. Ross JDC, Wilson J, Workowski KA, Taylor SN, Lewis DA, Gatsi S, et al. Oral gepotidacin for the treatment of uncomplicated urogenital gonorrhoea (EAGLE-1): a phase 3 randomised, open-label, non-inferiority, multicentre study. Lancet. 2025;405(10489):1608-20.  https://doi.org/10.1016/S0140-6736(25)00628-2  PMID: 40245902 
  15. Clinical and Laboratory Standards Institute (CLSI). Methods for dilution antimicrobial susceptibility tests for bacteria that grow aerobically; approved standard—ninth edition. CLSI document M07 A9. Wayne (PA): CLSI; 2012.
  16. Clinical and Laboratory Standards Institute (CLSI). Performance standards for antimicrobial susceptibility testing; twenty-fourth informational supplement. CLSI document M100‑S24. Wayne (PA): CLSI; 2014.
  17. Golparian D, Cole MJ, Sánchez-Busó L, Day M, Jacobsson S, Uthayakumaran T, et al. , Euro-GASP study group. Antimicrobial-resistant Neisseria gonorrhoeae in Europe in 2020 compared with in 2013 and 2018: a retrospective genomic surveillance study. Lancet Microbe. 2024;5(5):e478-88.  https://doi.org/10.1016/S2666-5247(23)00370-1  PMID: 38614111 
  18. Sánchez-Busó L, Yeats CA, Taylor B, Goater RJ, Underwood A, Abudahab K, et al. A community-driven resource for genomic epidemiology and antimicrobial resistance prediction of Neisseria gonorrhoeae at Pathogenwatch. Genome Med. 2021;13(1):61.  https://doi.org/10.1186/s13073-021-00858-2  PMID: 33875000 
  19. Golparian D, Maatouk I, Cherdtrakulkiat T, Doanh LH, Heng LS, Hoffman I, et al. Antimicrobial-resistant Neisseria gonorrhoeae in eight WHO Enhanced Gonococcal Antimicrobial Surveillance Programme (EGASP) sentinel countries in three WHO regions, 2021-2024: a genomic surveillance study.2025. Preprint at https://ssrn.com/abstract=5839058
  20. Ouk V, Say HL, Virak M, Deng S, Frankson R, McDonald R, et al. , EGASP Cambodia working group. World Health Organization Enhanced Gonococcal Antimicrobial Surveillance Programme, Cambodia, 2023. Emerg Infect Dis. 2024;30(7):1493-5.  https://doi.org/10.3201/eid3007.240354  PMID: 38916864 
  21. Fifer H, Doumith M, Rubinstein L, Mitchell L, Wallis M, Singh S, et al. Ceftriaxone-resistant Neisseria gonorrhoeae detected in England, 2015-24: an observational analysis. J Antimicrob Chemother. 2024;79(12):3332-9.  https://doi.org/10.1093/jac/dkae369  PMID: 39417254 
  22. Unemo M, Golparian D, Oxelbark J, Kong FYS, Brown D, Louie A, et al. Pharmacodynamic evaluation of ceftriaxone single-dose therapy (0.125-1 g) to eradicate ceftriaxone-susceptible and ceftriaxone-resistant Neisseria gonorrhoeae strains in a hollow fibre infection model for gonorrhoea. J Antimicrob Chemother. 2024;79(5):1006-13.  https://doi.org/10.1093/jac/dkae063  PMID: 38497988 
  23. Jacobsson S, Cole MJ, Schröder D, Jansen van Rensburg M, Day M, Ködmön C, et al. , Euro-GASP study group. Antimicrobial resistance in Neisseria gonorrhoeae and its risk groups in 23 European countries in 2022 within the European Gonococcal Antimicrobial Surveillance Programme (Euro-GASP): a retrospective observational study. Lancet Reg Health Eur. 2025;54:101318.  https://doi.org/10.1016/j.lanepe.2025.101318  PMID: 40487777 
  24. Spielman E, Mello MB, Schaefer R, Ong J, Schmidt HA, Henderson M, et al. Missed opportunities for guidance on sexually transmitted infection services: a global review of national HIV PrEP guidance. Sex Transm Infect. 2024;100(6):343-8.  https://doi.org/10.1136/sextrans-2023-056081  PMID: 38897729 
Extensively drug-resistant (XDR) Neisseria gonorrhoeae cured with ceftriaxone 2 g intravenous monotherapy in Croatia, March 2026
<p class="citation"> <span>Citation style for this article:</span> <span class="meta-value authors"> <a href="/search?value1=Tajana+Juzba%C5%A1i%C4%87&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Juzbašić Tajana</a>, <a href="/search?value1=Tatjana++Nemeth+Bla%C5%BEi%C4%87&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Nemeth Blažić Tatjana </a>, <a href="/search?value1=Nilia+Volarevi%C4%87&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Volarević Nilia</a>, <a href="/search?value1=Ivana+Be%C5%A1li%C4%87&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Bešlić Ivana</a>, <a href="/search?value1=Daniela++Gla%C5%BEar+Iv%C4%8De&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Glažar Ivče Daniela </a>, <a href="/search?value1=Ivana+Feren%C4%8Dak&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Ferenčak Ivana</a>, <a href="/search?value1=Dragan+Juri%C4%87&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Jurić Dragan</a>, <a href="/search?value1=Ljiljana+%C5%BDmak&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Žmak Ljiljana</a>, <a href="/search?value1=Dolores+Peru%C4%8D&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Peruč Dolores</a>, <a href="/search?value1=Susanne+Jacobsson&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Jacobsson Susanne</a>, <a href="/search?value1=Daniel+Golparian&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Golparian Daniel</a>, <a href="/search?value1=Ivana+Bo%C5%BEi%C4%8Devi%C4%87&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Božičević Ivana</a>, <a href="/search?value1=Iskra+Alexandra+Nola&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Nola Iskra Alexandra</a>, <a href="/search?value1=Magnus+Unemo&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Unemo Magnus</a></span>. Extensively drug-resistant (XDR) Neisseria gonorrhoeae cured with ceftriaxone 2 g intravenous monotherapy in Croatia, March 2026. <a href="/content/ecdc">Euro Surveill.</a> 2026;31(21):pii=2600422. <a href="https://doi.org/10.2807/1560-7917.ES.2026.31.21.2600422" title="doi link" target="_blank">https://doi.org/10.2807/1560-7917.ES.2026.31.21.2600422</a> <span class="ES_Article_citation"> <span class="generated">Received</span>: 14 May 2026;&nbsp;&nbsp; <span class="generated">Accepted</span>: 28 May 2026 </span> </p>
/content/10.2807/1560-7917.ES.2026.31.21.2600422
/content/10.2807/1560-7917.ES.2026.31.21.2600422
Loading

Data & Media loading...

Submit comment
Close
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