Australian Gonococcal Surveillance Programme Annual Report, 2023.

Abstract: The Australian Gonococcal Surveillance Programme (AGSP) has continuously monitored antimicrobial resistance in Neisseria gonorrhoeae 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 in vitro 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 N. gonorrhoeae 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 N. gonorrhoeae 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 Neisseria gonorrhoeae in the Northern Territory has effected a change in gonococcal treatment recommendations.