Antimicrobial-Resistant Neisseria gonorrhoeae of Public Health Concern, New South Wales, Australia, 2022-2024.

Antimicrobial-resistant Neisseria gonorrhoeae poses a serious public health threat. In Australia, N. 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.