---
title: "Antimicrobial resistance and whole-genome sequencing of Neisseria gonorrhoeae isolates, Bangrak ST"
id: "pubmed-42550164"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42550164"
content_type: "clinical_feed_article"
specialty: "Infectious Disease"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42550164/"
doi: "10.1093/jac/dkag260"
published_at: "2026-08-04T00:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Antimicrobial resistance and whole-genome sequencing of Neisseria gonorrhoeae isolates, Bangrak ST
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42550164
- **Specialty:** [Infectious Disease](https://medichelpline.com/clinical-feed/infectious-disease.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42550164/)
- **DOI:** [10.1093/jac/dkag260](https://doi.org/10.1093%2Fjac%2Fdkag260)
- **Published At:** 2026-08-04T00:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- This study evaluated **antimicrobial resistance** (AMR) in Neisseria gonorrhoeae isolates collected at the Bangrak STIs Center in Bangkok, Thailand from 2018 to 2023. - A total of 765 gonococcal isolates from 739 patients were cultured and tested for five antimicrobials using Etest and EUCAST breakpoints; ciprofloxacin was tested by disc diffusion. - Observed resistance rates were: **ceftriaxone** 0.5%, **cefixime** 0.8%, **azithromycin** 1.7%, tetracycline 83.7% and ciprofloxacin 95.7%. - **Ceftriaxone-resistant** isolates (n = 3) were first detected in 2023; all ceftriaxone-resistant isolates were also resistant to cefixime. - Additional cefixime-resistant isolates appeared in 2022 (n = 2). Azithromycin resistance emerged in 2020 and rose to nine isolates (3.7%) by 2023. - Whole-genome sequencing (WGS) was performed on isolates resistant to ceftriaxone, cefixime and/or azithromycin using Illumina NextSeq 550. - All ceftriaxone-resistant isolates carried **penA-60.001**; cefixime resistance was additionally associated with **penA-34.019** and **penA-10.001**. - All azithromycin-resistant isolates had 23S rRNA mutations and/or mosaic/semi-mosaic **MtrD**, a subunit of the MtrCDE efflux pump. - The authors conclude that resistance to ceftriaxone, cefixime and azithromycin has emerged and may be increasing locally, underscoring the need for strengthened culture-based and genomic surveillance and adoption of new oral treatments such as zoliflodacin and gepotidacin. - Details on patient demographics, exact numbers sequenced by WGS, and other laboratory specifics beyond methods reported were not provided in the abstract.
## Clinical Analysis & Structured Key Points
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Antimicrobial resistance in Neisseria gonorrhoeae isolates at the Bangrak STIs Center, Bangkok, Thailand and WGS of antimicrobial-resistant isolates, 2018-23 [Porntip Paopang](https://pubmed.ncbi.nlm.nih.gov/?term=Paopang+P&cauthor_id=42550164)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42550164/#full-view-affiliation-1 "Bangrak STIs Center, Division of AIDS and STIs, Department of Disease Control, Thailand Ministry of Public Health, Nonthaburi, Thailand."), [Pongsathorn Sangprasert](https://pubmed.ncbi.nlm.nih.gov/?term=Sangprasert+P&cauthor_id=42550164)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42550164/#full-view-affiliation-1 "Bangrak STIs Center, Division of AIDS and STIs, Department of Disease Control, Thailand Ministry of Public Health, Nonthaburi, Thailand."), [Daniel Golparian](https://pubmed.ncbi.nlm.nih.gov/?term=Golparian+D&cauthor_id=42550164)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42550164/#full-view-affiliation-2 "WHO Collaborating Centre for Gonorrhoea and Other STIs, Department of Laboratory Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden."), [Natnaree Girdthep](https://pubmed.ncbi.nlm.nih.gov/?term=Girdthep+N&cauthor_id=42550164)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42550164/#full-view-affiliation-1 "Bangrak STIs Center, Division of AIDS and STIs, Department of Disease Control, Thailand Ministry of Public Health, Nonthaburi, Thailand."), [Nutchaya Jintana](https://pubmed.ncbi.nlm.nih.gov/?term=Jintana+N&cauthor_id=42550164)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42550164/#full-view-affiliation-1 "Bangrak STIs Center, Division of AIDS and STIs, Department of Disease Control, Thailand Ministry of Public Health, Nonthaburi, Thailand."), [Supawadee Sonnak](https://pubmed.ncbi.nlm.nih.gov/?term=Sonnak+S&cauthor_id=42550164)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42550164/#full-view-affiliation-1 "Bangrak STIs Center, Division of AIDS and STIs, Department of Disease Control, Thailand Ministry of Public Health, Nonthaburi, Thailand."), [Padchara Sangsuk](https://pubmed.ncbi.nlm.nih.gov/?term=Sangsuk+P&cauthor_id=42550164)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42550164/#full-view-affiliation-3 "Department of Medical Technology and Clinical Pathology, Vachira Phuket Hospital, Phuket, Thailand."), [Thewarkrith Bunpan](https://pubmed.ncbi.nlm.nih.gov/?term=Bunpan+T&cauthor_id=42550164)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42550164/#full-view-affiliation-3 "Department of Medical Technology and Clinical Pathology, Vachira Phuket Hospital, Phuket, Thailand."), [Magnus Unemo](https://pubmed.ncbi.nlm.nih.gov/?term=Unemo+M&cauthor_id=42550164)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42550164/#full-view-affiliation-2 "WHO Collaborating Centre for Gonorrhoea and Other STIs, Department of Laboratory Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.")[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42550164/#full-view-affiliation-4 "Institute for Global Health, University College London, London, UK."), [Rossaphorn Kittiyaowamarn](https://pubmed.ncbi.nlm.nih.gov/?term=Kittiyaowamarn+R&cauthor_id=42550164)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42550164/#full-view-affiliation-1 "Bangrak STIs Center, Division of AIDS and STIs, Department of Disease Control, Thailand Ministry of Public Health, Nonthaburi, Thailand.") Affiliations Expand ### Affiliations * 1 Bangrak STIs Center, Division of AIDS and STIs, Department of Disease Control, Thailand Ministry of Public Health, Nonthaburi, Thailand. * 2 WHO Collaborating Centre for Gonorrhoea and Other STIs, Department of Laboratory Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden. * 3 Department of Medical Technology and Clinical Pathology, Vachira Phuket Hospital, Phuket, Thailand. * 4 Institute for Global Health, University College London, London, UK. * PMID: **42550164** * DOI: [ 10.1093/jac/dkag260 ](https://doi.org/10.1093/jac/dkag260) Item in Clipboard # Antimicrobial resistance in Neisseria gonorrhoeae isolates at the Bangrak STIs Center, Bangkok, Thailand and WGS of antimicrobial-resistant isolates, 2018-23 Porntip Paopang et al. J Antimicrob Chemother. 2026. Show details Display options Display options Format Abstract PubMed PMID J Antimicrob Chemother Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22J+Antimicrob+Chemother%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22J+Antimicrob+Chemother%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42550164/) . 2026 Aug 4;81(9):dkag260. doi: 10.1093/jac/dkag260. ### Authors [Porntip Paopang](https://pubmed.ncbi.nlm.nih.gov/?term=Paopang+P&cauthor_id=42550164)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42550164/#short-view-affiliation-1 "Bangrak STIs Center, Division of AIDS and STIs, Department of Disease Control, Thailand Ministry of Public Health, Nonthaburi, Thailand."), [Pongsathorn Sangprasert](https://pubmed.ncbi.nlm.nih.gov/?term=Sangprasert+P&cauthor_id=42550164)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42550164/#short-view-affiliation-1 "Bangrak STIs Center, Division of AIDS and STIs, Department of Disease Control, Thailand Ministry of Public Health, Nonthaburi, Thailand."), [Daniel Golparian](https://pubmed.ncbi.nlm.nih.gov/?term=Golparian+D&cauthor_id=42550164)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42550164/#short-view-affiliation-2 "WHO Collaborating Centre for Gonorrhoea and Other STIs, Department of Laboratory Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden."), [Natnaree Girdthep](https://pubmed.ncbi.nlm.nih.gov/?term=Girdthep+N&cauthor_id=42550164)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42550164/#short-view-affiliation-1 "Bangrak STIs Center, Division of AIDS and STIs, Department of Disease Control, Thailand Ministry of Public Health, Nonthaburi, Thailand."), [Nutchaya Jintana](https://pubmed.ncbi.nlm.nih.gov/?term=Jintana+N&cauthor_id=42550164)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42550164/#short-view-affiliation-1 "Bangrak STIs Center, Division of AIDS and STIs, Department of Disease Control, Thailand Ministry of Public Health, Nonthaburi, Thailand."), [Supawadee Sonnak](https://pubmed.ncbi.nlm.nih.gov/?term=Sonnak+S&cauthor_id=42550164)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42550164/#short-view-affiliation-1 "Bangrak STIs Center, Division of AIDS and STIs, Department of Disease Control, Thailand Ministry of Public Health, Nonthaburi, Thailand."), [Padchara Sangsuk](https://pubmed.ncbi.nlm.nih.gov/?term=Sangsuk+P&cauthor_id=42550164)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42550164/#short-view-affiliation-3 "Department of Medical Technology and Clinical Pathology, Vachira Phuket Hospital, Phuket, Thailand."), [Thewarkrith Bunpan](https://pubmed.ncbi.nlm.nih.gov/?term=Bunpan+T&cauthor_id=42550164)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42550164/#short-view-affiliation-3 "Department of Medical Technology and Clinical Pathology, Vachira Phuket Hospital, Phuket, Thailand."), [Magnus Unemo](https://pubmed.ncbi.nlm.nih.gov/?term=Unemo+M&cauthor_id=42550164)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42550164/#short-view-affiliation-2 "WHO Collaborating Centre for Gonorrhoea and Other STIs, Department of Laboratory Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.")[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42550164/#short-view-affiliation-4 "Institute for Global Health, University College London, London, UK."), [Rossaphorn Kittiyaowamarn](https://pubmed.ncbi.nlm.nih.gov/?term=Kittiyaowamarn+R&cauthor_id=42550164)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42550164/#short-view-affiliation-1 "Bangrak STIs Center, Division of AIDS and STIs, Department of Disease Control, Thailand Ministry of Public Health, Nonthaburi, Thailand.") ### Affiliations * 1 Bangrak STIs Center, Division of AIDS and STIs, Department of Disease Control, Thailand Ministry of Public Health, Nonthaburi, Thailand. * 2 WHO Collaborating Centre for Gonorrhoea and Other STIs, Department of Laboratory Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden. * 3 Department of Medical Technology and Clinical Pathology, Vachira Phuket Hospital, Phuket, Thailand. * 4 Institute for Global Health, University College London, London, UK. * PMID: **42550164** * DOI: [ 10.1093/jac/dkag260 ](https://doi.org/10.1093/jac/dkag260) Item in Clipboard Cite Display options Display options Format Abstract PubMed PMID ## Abstract **Objectives:** Antimicrobial resistance (AMR) in Neisseria gonorrhoeae is a global public health concern, particularly due to increasing resistance to the last remaining monotherapy, ceftriaxone, in several Asian countries. We examined the AMR of gonococcal isolates obtained at the Bangrak STIs Center, Bangkok, Thailand in 2018-23, and used WGS on isolates resistant to ceftriaxone, cefixime and/or azithromycin. **Methods:** Genital and extragenital swabs from males, females and transgender women were cultured. Etest (five antimicrobials) and EUCAST breakpoints (v16.0), or disc diffusion method (ciprofloxacin) were used to determine AMR. WGS was performed using Illumina NextSeq 550. **Results:** In 2018-23, 765 gonococcal isolates from 739 patients were cultured. Resistance to ceftriaxone, cefixime, azithromycin, tetracycline and ciprofloxacin was 0.5%, 0.8%, 1.7%, 83.7% and 95.7%, respectively. Ceftriaxone-resistant isolates, all resistant also to cefixime, were first detected in 2023 (n = 3, 1.2%). Additional cefixime-resistant isolates were found in 2022 (n = 2, 1.4%). Azithromycin-resistant isolates first emerged in 2020 (n = 1, 0.9%) and increased to nine (3.7%) isolates in 2023. All ceftriaxone-resistant isolates contained penA-60.001, but cefixime resistance was additionally caused by penA-34.019 and penA-10.001. All azithromycin-resistant isolates had 23S rRNA mutations and/or mosaic/semi-mosaic MtrD (subunit of the MtrCDE efflux pump). **Conclusions:** Resistance to ceftriaxone, cefixime and azithromycin has emerged in gonococcal strains circulating in Bangkok, Thailand, and resistance appears to be increasing. Resistance to these last options for monotherapy or dual therapy emphasize the need for strengthened national culture-based and genomic surveillance to prevent the spread of MDR and XDR strains in Thailand and globally, and implementation of the novel oral treatments, i.e. zoliflodacin and gepotidacin. © The Author(s) 2026. Published by Oxford University Press on behalf of British Society for Antimicrobial Chemotherapy. [PubMed Disclaimer](https://pubmed.ncbi.nlm.nih.gov/disclaimer/) ## MeSH terms * Anti-Bacterial Agents* / pharmacology Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Anti-Bacterial+Agents%2Fpharmacology%22%5BMAJR%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Anti-Bacterial+Agents) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42550164/) * Azithromycin / pharmacology Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Azithromycin%2Fpharmacology%22%5BMeSH%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Azithromycin) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42550164/) * Cefixime / pharmacology Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Cefixime%2Fpharmacology%22%5BMeSH%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Cefixime) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42550164/) * Ceftriaxone / pharmacology Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Ceftriaxone%2Fpharmacology%22%5BMeSH%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Ceftriaxone) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42550164/) * Drug Resistance, Bacterial* Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Drug+Resistance%2C+Bacterial%22%5BMAJR%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Drug+Resistance%2C+Bacterial) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42550164/) * Drug Resistance, Multiple, Bacterial* / genetics Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Drug+Resistance%2C+Multiple%2C+Bacterial%2Fgenetics%22%5BMAJR%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Drug+Resistance%2C+Multiple%2C+Bacterial) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42550164/) * Female Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Female%22%5BMeSH%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Female) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42550164/) * Gonorrhea* / drug therapy Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Gonorrhea%2Fdrug+therapy%22%5BMAJR%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Gonorrhea) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42550164/) * Gonorrhea* / epidemiology Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Gonorrhea%2Fepidemiology%22%5BMAJR%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Gonorrhea) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42550164/) * Gonorrhea* / microbiology Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Gonorrhea%2Fmicrobiology%22%5BMAJR%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Gonorrhea) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42550164/) * Humans Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Humans%22%5BMeSH%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.g
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