In 2013 the United States Centres for Disease Control Threat Report rated Gonococcal AMR as an urgent Public Health Threat. The treatment guidelines from the United States, The United Kingdom and Europe recommend dual treatment with ceftriaxone and azithromycin for uncomplicated gonorrhoea. This is also the recommendation for the majority of Australia, however, in some remote regions of Australia, amongst the Indigenous population resistance rates are very low, and gonorrhoea acquired locally or in an endemic region can be treated with oral penicillin based protocol. In these remote areas antimicrobial resistance (AMR) testing is difficult however molecular tests have been developed and implemented to enhance isolate based surveillance.

In 2013, in Australia, decreased susceptibility to ceftriaxone was reported in 8.8% of isolates, double that reported in 2012 (4.4%). The highest proportions were reported from New South Wales and Victoria where the greatest increases in disease notifications occurred. Genotypic data generated by members of the NNN show that strains harbouring a mosaic penicillin-binding protein 2 – considered a pivotal mechanism for cephalosporin resistance – now comprise approximately 8% of all gonococcal infections in Australia.  Further, in 2013, a new multidrug resistant gonococcal strain (A8806) with a ceftriaxone MIC of 0.5mg/L, the highest ever reported in Australia, had key genetic similarities to a rare ceftriaxone-resistant strain, observed in only a single case in Asia.  Enhanced surveillance for the A8806 strain was implemented.   

In summary, gonococcal disease rates and AMR rates are increasing, and in 2013 the proportion of strains with elevated ceftriaxone MIC values has doubled since 2012. For the first time in Australia, ceftriaxone resistance and high level resistance to azithromycin has been reported. The next direction for treatment is uncertain, but what is clear is that gonococcal AMR poses a serious public health threat and disease prevention and disease control programs are urgently called for, and that continued monitoring of AMR to inform treatment and monitor interventions is paramount. Molecular surveillance is now in place to enhance isolate based surveillance in Australia.