Gonorrhoea treatment failure caused by the first Neisseria gonorrhoeae strain with combined ceftriaxone and high-level azithromycin resistance globally

Antimicrobial resistance in Neisseria gonorrhoeae is a major public health concern. We describe the first reported gonorrhoea case globally with combined high-level azithromycin resistance and ceftriaxone resistance, the last mainstream treatment agents. A 50-year-old male was diagnosed in February 2018 in the UK following sexual intercourse with a female in Thailand. Using whole-genome sequencing, we determined resistance arose from two existing mechanisms combining for the first time, occurring in a commonly circulating strain. The most closely-related previously sequenced isolates were obtained in China, Japan and the UK. Urgent action is needed to contain the further spread of the isolate identified.