Figure. Maximum-likelihood phylogeny of Neisseria gonorrhoeae samples (N = 62) collected in Hawaii during February–May 2016, 1 isolate collected in Hawaii in 2011, and 1 isolate collected in the United Kingdom in 2015. The clade denoted with the black vertical bar contains 8 samples that exhibited resistance to azithromycin (MIC >256 µg/mL by Etest) and reduced susceptibility to ceftriaxone (MIC range 0.094–0.125 µg/mL). The 2011 isolate from Hawaii (H11S8, bold) also exhibited resistance to azithromycin. The United Kingdom isolate (underlined) was associated with failed dual antimicrobial therapy of ceftriaxone and azithromycin. The phylogeny is based on the core genome single nucleotide polymorphism alignment of the 62 genomes and the FA19 reference genome. Values on the nodes of the phylogeny (based on 1,000 bootstrap replicates) represent the support for each node and the corresponding clade. Scale bar indicates substitutions per site.