Neisseria gonorrhoeae-Susceptibility Trends and Basic Molecular Mapping of Isolates Collected in Israel in 2016-2022

Neisseria gonorrhoeae (NG) is a globally significant sexually transmitted infection (STI) with increasing antimicrobial resistance (AMR), posing a serious threat to public health. Between 2016 and 2022, the Israeli National NG Reference Center (INNGRC) comprehensively analyzed NG isolates in Israel to determine AMR patterns and sequence types (STs). Antimicrobial susceptibility testing (AST) was performed on 1205 NG isolates using E-test gradient strips, and NG-MAST analysis was conducted on 279 isolates via Sanger sequencing and whole genome sequencing (WGS). Surveillance revealed high resistance rates to ciprofloxacin (54.4%), azithromycin (41.3%), tetracycline, and benzylpenicillin, while all isolates remained susceptible to ceftriaxone and spectinomycin. Multi-drug resistance (MDR) was observed in 8.6% of isolates, and 3% were classified as extensively drug-resistant (XDR). NG-MAST analysis identified 72 distinct STs, with ST292, ST4269, and ST5441 being the most prevalent. ST19665 and ST11461 predominated in 2022, while ST292, ST5441, and ST16169 were more abundant in 2018. The findings highlight the increasing prevalence of AMR in NG in Israel and underscore the importance of continuous surveillance and molecular characterization by reference laboratories like the INNGRC to inform treatment strategies and public health interventions, ultimately reducing the burden of this critical STI.