Limitations of Global Surveillance for Neisseria gonorrhoeae Antimicrobial Resistance

Neisseria gonorrhoeae bacteria cause ≈82 million infections annually worldwide. As antimicrobial resistance (AMR) accelerates, the actual prevalence of antimicrobial-resistant infections remains obscured because of fragmented, heterogeneous, and often absent surveillance systems. The efficacy of ceftriaxone, widely used as first-line therapy, is increasingly threatened by the expansion of strains harboring the mosaic penA 60.001 allele, first documented in 2015 and now recognized globally as the dominant determinant of AMR. Our systematic search of the published literature identified 212 such isolates; nearly half were detected after 2022 in England and Australia, and epidemiologic data frequently linked acquisition of infection to the Asia-Pacific region. The substantially higher case numbers reported in those countries reflect the strength of their gonococcal AMR surveillance systems and more timely public data sharing. Our findings suggest that underreporting of the actual prevalence of ceftriaxone resistance is likely and that the opportunity for action is limited.