Australian Gonococcal Surveillance Programme Annual Report, 2019.

The Australian Gonococcal Surveillance Programme (AGSP) has continuously monitored antimicrobial resistance in clinical isolates of Neisseria gonorrhoeae since 1981. In 2019, a total of 9,668 clinical isolates of gonococci from the public and private sector in all jurisdictions were tested for in vitro antimicrobial susceptibility by standardised methods. The current treatment recommendation for gonorrhoea, for the majority of Australia, continues to be dual therapy with ceftriaxone and azithromycin. Decreased susceptibility (DS) to ceftriaxone (minimum inhibitory concentration [MIC] value ≥ 0.06 mg/L) was found nationally in 1.3% of isolates. Five N. gonorrhoeae clinical isolates were ceftriaxone-resistant (MIC value ≥ 0.25 mg/L), and therefore also resistant to penicillin; all were resistant to ciprofloxacin but susceptible to azithromycin. These isolates were reported from Victoria (3), non-remote Western Australia (1) and New South Wales (1). Resistance to azithromycin (MIC value ≥ 1.0 mg/L) was found nationally in 4.6% of N. gonorrhoeae isolates, continuing a downward trend observed and reported since 2017. Isolates with high-level resistance to azithromycin (MIC value ≥ 256 mg/L) continue to be reported sporadically in Australia, with eight detected in 2019: two each from New South Wales, Queensland, and Victoria, and one each from Tasmania and non-remote Western Australia. In 2019, in Australia, 2,136 gonococcal isolates (22.1%) were penicillin resistant; however, there remains considerable variation by jurisdiction, and in some remote settings there is little resistance and this drug is recommended empiric therapy. In 2019, in the remote Northern Territory, no penicillin resistance was reported, however in remote Western Australia six out of 85 isolates (7.1%) were penicillin resistant. There was no ciprofloxacin resistance reported from isolates tested from remote regions of the Northern Territory, and ciprofloxacin resistance rates remain comparatively low (7/85; 8.2%) in remote Western Australia.