Antimicrobial-resistant Neisseria gonorrhoeae poses a serious public health threat. gonorrhoeae isolates with ceftriaxone MICs > 0.125 mg/L or azithromycin MICs > 256 mg/L required follow-up by public health officials. Odds of culture-positive notifications meeting those criteria increased from 2017–2019 (n = 11) to 2022–2024 (n = 94) (odds ratio 8.58 [95% CI 4.81–17.0]).
Local acquisition was frequent (78.7%). Isolates with decreased ceftriaxone susceptibility were more common in female and heterosexual patients than were isolates with high-level azithromycin resistance. We identified 9 genomically linked clusters (< 15 single-nucleotide polymorphisms), 3 with sizable clonal expansion.
Initial test of cure was negative for 81/94 (86.2%) 2022–2024 cases; of the rest, 9 cases had no follow-up visits, 2 were reinfected, and 2 failed initial treatment. Improving follow-up and reporting of treatment failure would strengthen case management protocols. Culture-based diagnostics remain essential to detect antimicrobial resistance, inform surveillance, and curb the rising resistance trend.