The need for a commercial test using the penA60 allele to identify ceftriaxone-resistant Neisseria gonorrhoeae

Ceftriaxone is the principal treatment for gonorrhoea in most jurisdictions because of widespread Neisseria gonorrhoeae resistance to other antimicrobials, including penicillin, ciprofloxacin, and, increasingly, azithromycin. With few alternate treatment options available for gonorrhoea, resistance to third-generation cephalosporins (such as ceftriaxone) was identified in 2013 as an urgent threat by the US Centers for Disease Control and Prevention in Antibiotic Resistance Threats in the United States. Almost a decade later, there remains a lack of new antimicrobials, and surveillance of gonococcal antimicrobial resistance is non-existent or poorly representative because of low numbers of isolates in many high-risk, low-income and middle-income settings and a reliance on molecular diagnostics in high-income settings. Additionally, in many settings, N gonorrhoeae antimicrobial resistance surveillance has primarily focused on urogenital specimens because of poor culture sensitivity for extragenital sites, despite reported cases of failed cephalosporin treatment typically involving pharyngeal infection.