Rise of Neisseria gonorrhoeae with mosaic penA-34, France, 2018-2023
François Camelena1,2,3, Manel Merimèche1,2,3, Mary Mainardis1,2,3
1Laboratory of Bacteriology, Hospital Saint-Louis and Lariboisière, Assistance-Publique Hôpitaux de Paris, Paris, France.
Antimicrobial Agents and Chemotherapy
|May 6, 2026
Abstract:
Surveillance of antimicrobial resistance in Neisseria gonorrhoeae was conducted in France from 2018 to 2023. The proportion of isolates with cefixime MIC ≥ 0.032 mg/L increased from 8.1% in 2018-2022 to 23.5% in 2023. This sharp rise was driven by the expansion of two clones, ST1580 and ST16676, carrying the mosaic penA-34.001 and penA-34.007 alleles, respectively. These findings highlight the essential role of genomic surveillance in monitoring the evolution of resistance determinants in N. gonorrhoeae.
Insights
Antimicrobial resistance in Neisseria gonorrhoeae is rising in France, with cefixime resistance jumping to 23.5% in 2023. This increase is linked to specific bacterial clones carrying new resistance genes.
Area of Science:
- Microbiology
- Genomics
- Public Health
Background:
- Neisseria gonorrhoeae is a significant cause of sexually transmitted infections.
- Antimicrobial resistance (AMR) is a growing global health threat, complicating treatment of gonococcal infections.
- Continuous monitoring of AMR patterns is crucial for effective public health interventions.
Purpose of the Study:
- To monitor antimicrobial resistance trends in Neisseria gonorrhoeae in France between 2018 and 2023.
- To identify the genetic mechanisms and bacterial clones driving observed resistance patterns.
- To emphasize the importance of genomic surveillance for tracking AMR evolution.
Main Methods:
- Genomic surveillance of Neisseria gonorrhoeae isolates collected in France from 2018 to 2023.
- Antimicrobial susceptibility testing, including determination of Minimum Inhibitory Concentrations (MICs) for cefixime.
- Molecular characterization of resistance determinants, specifically focusing on penA mosaic alleles and clonal lineages (STs).
Main Results:
- A significant increase in cefixime resistance was observed, with the proportion of isolates having a cefixime MIC ≥ 0.032 mg/L rising from 8.1% in 2018-2022 to 23.5% in 2023.
- This surge in resistance was primarily attributed to the expansion of two specific clones: ST1580 and ST16676.
- These clones were identified as carrying the mosaic penA-34.001 and penA-34.007 alleles, respectively, which are associated with reduced susceptibility to cefixime.
Conclusions:
- The study highlights a concerning rise in cefixime resistance in Neisseria gonorrhoeae in France.
- The expansion of specific ST clones carrying novel penA mosaic alleles is the main driver of this increasing resistance.
- Genomic surveillance is indispensable for timely detection and management of evolving antimicrobial resistance in N. gonorrhoeae.
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