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Volume 32, Number 6—June 2026

Research

Antimicrobial-Resistant Neisseria gonorrhoeae of Public Health Concern, New South Wales, Australia, 2022–2024

Liz J. Walker1Comments to Author , Sebastiaan J. Van Hal1, Cecilia Li, Steven J. Nigro, Ellen Donnan, Nathan Ryder, Monica Lahra2, and Janaki Amin2
Author affiliation: NSW Health, St. Leonards, New South Wales, Australia (L.J. Walker, C. Li, S.J. Nigro, E. Donnan, N. Ryder, J. Amin); Royal Prince Alfred Hospital, Sydney, New South Wales, Australia (S.J. van Hal); The University of Sydney Central Clinical School, Sydney (S.J. van Hal); The University of Sydney Institute for Infectious Diseases, Sydney (E. Donnan); Prince of Wales Hospital and Community Health Services, Randwick, New South Wales, Australia (M.M. Lahra); University of New South Wales, Sydney (M.M. Lahra); Macquarie University, Sydney (J. Amin)

Main Article

Table 3

Characteristics of antimicrobial-resistant Neisseria gonorrhoeae cases of public health concern, New South Wales, Australia, 2022–2024*

Characteristic Overall, N = 94 Ceftriaxone DS, n = 54 Azithromycin HLR, n = 40 p value
Patient age at diagnosis, median (IQR)
 33 (25–42)
 36 (24–43)
 30 (27–36)
 0.12†
Sex at birth <0.001‡
F 18 (19.1) 17 (31.5) 1 (2.5)
M
 76 (80.9)
 37 (68.5)
 39 (97.5)
Sexual risk group <0.001‡
Heterosexual 41 (43.6) 39 (72.2) 2 (5.0)
MSM 49 (52.1) 14 (25.9) 35 (87.5)
Bisexual
 4 (4.3)
 1 (1.9)
 3 (7.5)
Previous STI <0.002‡
Y 47 (50.0) 19 (35.2) 28 (70.0)
N
 47 (50.0)
 35 (64.8)
 12 (30.0)
Most recent previous STI occurrence§ 0.7‡
Co-infection 18 (38.3) 7 (36.8) 11 (39.3)
<1 y 22 (46.8) 8 (42.1) 14 (50.0)
>1 y 7 (14.9) 4 (21.1) 3 (10.7)
None
 47
 35
 12
No. previous STIs, median (IQR) 3 (1–5) 2 (1–4) 4 (2–6) 0.11‡
Unknown
 47
 35
 12
Sex worker or client or SOPV attendance 0.13‡
Yes 15 (16.0) 10 (18.5) 5 (12.5)
No 38 (40.4) 17 (31.5) 24 (60.0)
Unknown
 41 (43.6)
 27 (50.0)
 14 (35.0)
Signs and symptoms 0.095‡
Symptomatic 63 (67.0) 38 (70.4) 25 (62.5)
Asymptomatic 24 (25.5) 10 (18.5) 14 (35.0)
Unknown
 7 (7.4)
 6 (11.1)
 1 (2.5)
Site of infection <0.001‡
Genitourinary tract 58 (61.7) 44 (81.5) 14 (35.0)
Rectal 18 (19.1) 3 (5.6) 15 (37.5)
Pharynx 12 (12.8) 4 (7.4) 8 (20.0)
Eye 1 (1.1) 1 (1.9) 0
Multiple sites
 5 (5.3)
 2 (3.7)
 3 (7.5)
Source of infection <0.001‡
Australia 74 (78.7) 46 (85.2) 28 (70.0)
Africa 1 (1.1) 0 1 (2.5)
Americas 6 (6.4) 0 6 (15.0)
Europe 3 (3.2) 0 3 (7.5)
Western Pacific 9 (9.6) 7 (13.0) 2 (5.0)
Unknown
 1 (1.1)
 1 (1.9)
 0
Partners within 2-month lookback
Total no. partners, median (IQR) 2 (1–5) 1 (1–2) 5 (2–9) <0.001‡
Unknown
 26
 17
 9
Diagnosing facility 0.001‡
General practice 28 (29.8) 22 (40.7) 6 (15.0)
Sexual health clinic 62 (66.0) 28 (51.9) 34 (85.0)
Hospital
 4 (4.3)
 4 (7.4)
 0
Locality 0.030‡
Metropolitan 90 (95.7) 54 (100.0) 36 (90.0)
Regional
 4 (4.3)
 0
 4 (10.0)
Outcome of initial test of cure 0.14‡
Negative 81 (86.2) 44 (81.5) 37 (92.5)
Positive 4 (4.3) 2 (3.7) 2 (5.0)
No follow-up visits 9 (9.6) 8 (14.8) 1 (2.5)

*Values are no. (%) except as indicated. Ceftriaxone DS is defined as MIC >0.125 mg/L; azithromycin HLR is defined as MIC >256 mg/L. Bold text indicates statistical significance. DS, decreased susceptibility; HLR, high-level resistance; IQR, interquartile range; MSM, men who have sex with men; SOPV, sex on premises venue; STI, sexually transmitted infection. †By Wilcoxon rank-sum test. ‡By Fisher exact test. §Categorizes the most recent STI occurrence.

Main Article

1These first authors contributed equally to this article.

2These joint senior authors contributed equally to this article.

Page created: April 30, 2026
Page updated: June 01, 2026
Page reviewed: June 01, 2026
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