The emergence and introduction of mosaicism-carrying Neisseria gonorrhoeae lineages boosts local transmission: a genomic epidemiology study

The emergence of mosaic-carrying Neisseria gonorrhoeae lineages is a public health concern in the Valencian Region (VR) of Spain. This study used genomic epidemiology to analyze 1,647 isolates from 2012 to 2024. Key lineages like NG-STAR CC63, CC1387, and CC158 drive local transmission and resistance, with CC63 and CC1387 linked to higher azithromycin MICs, and CC158 associated with ciprofloxacin and ceftriaxone resistance. Mosaic alleles in penA and the mtr operon play a key role in AMR. This study highlights the need for ongoing genomic surveillance to track AMR evolution and support new treatment strategies, offering a model for regions facing similar gonococcal challenges.