Australian Gonococcal Surveillance Programme Annual Report, 2023

The Australian Gonococcal Surveillance Programme (AGSP) has continuously monitored antimicrobial resistance in <i>Neisseria gonorrhoeae</i> for more than 40 years. In 2023, a total of 10,105 isolates from patients in the public and private sectors, in all jurisdictions, were tested for <i>in vitro</i> antimicrobial susceptibility by standardised methods. Nationally, in 2023, the AGSP captured antimicrobial susceptibility data for 25% of all gonococcal infection notifications. The current treatment recommendation for gonorrhoea, for the majority of Australia, continues to be dual therapy with ceftriaxone and azithromycin. In 2023, of <i>N. gonorrhoeae</i> isolates tested, 0.22% (22/10,105) met the WHO criterion for ceftriaxone decreased susceptibility (DS), defined as a minimum inhibitory concentration (MIC) value ≥ 0.125 mg/L. Resistance to azithromycin was reported in 4.5% of <i>N. gonorrhoeae</i> isolates, proportionally stable since 2019. There were 27 isolates (0.27%) with high-level resistance to azithromycin (MIC value ≥ 256 mg/L) reported in Australia: Victoria (13), New South Wales (11), non-remote Western Australia (2) and Queensland (1). This is the highest number ever detected and reported in a twelve-month period by the AGSP. In 2023, penicillin resistance was found in 30.7% of gonococcal isolates, and ciprofloxacin resistance in 60.3%, although there was considerable variation by jurisdiction. In some remote settings, penicillin remains recommended as part of an empiric therapy strategy. However, in 2023, in remote Northern Territory, five penicillin-resistant isolates were reported; and in remote Western Australia, 14.1% of gonococcal isolates (10/71) were penicillin resistant. In addition, there were eight ciprofloxacin-resistant isolates reported from remote Northern Territory; ciprofloxacin resistance rates have increased in remote Western Australia (16/71; 22.5%). This increase in penicillin-resistant <i>Neisseria gonorrhoeae</i> in the Northern Territory has effected a change in gonococcal treatment recommendations.