Extensively drug-resistant (XDR) Neisseria gonorrhoeae causing possible gonorrhoea treatment failure with ceftriaxone plus azithromycin in Austria

Ceftriaxone resistance combined with high-level azithromycin resistance in N. gonorrhoeae is a concern for future treatment of gonorrhoea and poses a major global public health threat. Improved prevention (including condom use), early and accurate diagnosis and effective, affordable and accessible treatment (ideally including test of cure and contact notification and treatment) of gonorrhoea are imperative. Furthermore, increased awareness of the spread of ceftriaxone-resistant strains and rapid identification and eradication of the sporadic XDR gonococcal strains are essential to avoid any clonal expansion and sustained transmission of these strains. Enhanced antimicrobial resistance surveillance, ideally including test of cure and whole-genome sequencing, nationally and internationally, particularly in Asia where many ceftriaxone-resistant strains appear to have emerged, is of highest importance. Ultimately, novel antimicrobials for effective treatment of gonorrhoea and/or a sufficiently effective gonococcal vaccine will be crucial.