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In total, 6723 isolates detected in Stockholm, Sweden, from January 2016 to September 2022, were examined for antimicrobial susceptibilities by using <jats:italic>E<\/jats:italic>-test. Whole-genome sequencing (WGS) was applied to isolates in sentinel surveillance and isolates resistant to extended-spectrum cephalosporins (ESCs) or high-level azithromycin (HLAzi-R, MIC \u2265 256 mg\/L). As sentinel surveillance, consecutive clinical isolates (<jats:italic>n<\/jats:italic> = 396) detected every 4th week from January 2021 to September 2022 were enrolled in the study. Of the 6723 isolates investigated, 33 isolates (&lt; 1%) were found to be resistant to cefixime, one of which was co-resistant to ceftriaxone and ciprofloxacin and was detected in September 2022. Ten isolates presented a high level of azithromycin resistance. Resistant rates to ciprofloxacin varied from 32 in 2017 to 68\u201369% in 2021\u20132022. Elevated MIC<jats:sub>50<\/jats:sub> and MIC<jats:sub>90<\/jats:sub> of azithromycin were observed over the years. No resistance to spectinomycin was identified. The most frequently occurring MLST in the sentinel surveillance was ST9362 (23%), followed by ST11706 (9%), ST7359 (8%), ST10314 (7%), and ST11422 (6%). The ceftriaxone-resistant isolate belonged to ST8130 and the novel NG-STAR ST4859. Genomic resistance traits found in this strain included mutations in genes <jats:italic>mtrR<\/jats:italic> (A39T), <jats:italic>parC<\/jats:italic> (S87N), and <jats:italic>gyrA<\/jats:italic> (S91F and D95A), as well as the presence of <jats:italic>bla<\/jats:italic>TEM-135 and <jats:italic>tetM<\/jats:italic> genes. A predominance of ST9362 was observed in Stockholm. The high number of azithromycin and ciprofloxacin-resistant isolates and the emergence of a strain with a novel NG-STAR are of great concern.<\/jats:p>","DOI":"10.1007\/s10096-023-04633-6","type":"journal-article","created":{"date-parts":[[2023,7,13]],"date-time":"2023-07-13T17:02:00Z","timestamp":1689267720000},"page":"1073-1079","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Antimicrobial susceptibilities and genomic epidemiology of Neisseria gonorrhoeae in Stockholm, Sweden"],"prefix":"10.1007","volume":"42","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1576-7995","authenticated-orcid":false,"given":"Nora","family":"Vestberg","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karin Haij","family":"Bhattarai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hong","family":"Fang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2023,7,13]]},"reference":[{"issue":"5","key":"4633_CR1","doi-asserted-by":"publisher","first-page":"1454","DOI":"10.1128\/JCM.00100-17","volume":"55","author":"W Demczuk","year":"2017","unstructured":"Demczuk W, Sidhu S, Unemo M, Whiley DM, Allen VG, Dillon JR, Cole M, Seah C, Trembizki E, Trees DL, Kersh EN, Abrams AJ, de Vries H, van Dam AP, Medina I, Bharat A, Mulvey MR, Van Domselaar G, Martin I (2017) Neisseria gonorrhoeae sequence typing for antimicrobial resistance, a novel antimicrobial resistance multilocus typing scheme for tracking global dissemination of N. gonorrhoeae strains. 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Ethical approval and informed consent were not required.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to participate"}},{"value":"Not applicable.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}]}}