{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T02:16:28Z","timestamp":1784081788265,"version":"3.55.0"},"reference-count":49,"publisher":"CSIRO Publishing","issue":"5","license":[{"start":{"date-parts":[[2025,8,18]],"date-time":"2025-08-18T00:00:00Z","timestamp":1755475200000},"content-version":"vor","delay-in-days":2175,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,9,13]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Although rare, Neisseria gonorrhoeae treatment failures associated with ceftriaxone have been reported. The World Health Organization (WHO) recommends standardised protocols to verify these cases. Two cases from Australia were previously investigated using N. gonorrhoeae multiantigen sequence typing (NG-MAST), which has been used extensively to assess treatment failures. Case 1 pharyngeal isolates were indistinguishable, whereas Case 2 pharyngeal isolates were distinguished based on an 18-bp deletion in the major outer membrane porin encoded by the porB gene, questioning the reliability of NG-MAST results. Here we used whole-genome sequencing (WGS) to reinvestigate Cases 1 and 2, with a view to examining WGS to assess treatment failures. Methods: Pre- and post-treatment isolates for each case underwent Illumina sequencing, and the two post-treatment isolates underwent additional long-read sequencing using Pacific Biosciences. Sequence data were interrogated to identify differences at single nucleotide resolution. Results: WGS identified variation in the pilin subunit encoded by the pilE locus for both cases and the specific 18-bp porB deletion in Case 2 was confirmed, but otherwise the isolates in each case were indistinguishable. Conclusions: The WHO recommends standardised protocols for verifying N. gonorrhoeae treatment failures. Case 2 highlights the enhanced resolution of WGS over NG-MAST and emphasises the immediate effect that WGS can have in a direct clinical application for N. gonorrhoeae. Assessing the whole genome compared with two highly variable regions also provides a more confident predictor for determining treatment failure. Furthermore, WGS facilitates rapid comparisons of these cases in the future.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1071\/sh19012","type":"journal-article","created":{"date-parts":[[2019,9,4]],"date-time":"2019-09-04T08:25:51Z","timestamp":1567585551000},"page":"500-507","source":"Crossref","is-referenced-by-count":4,"title":["Whole-genome sequencing as an improved means of investigating Neisseria gonorrhoeae treatment failures"],"prefix":"10.1071","volume":"16","author":[{"given":"Cameron","family":"Buckley","sequence":"first","affiliation":[{"name":"AFaculty of Medicine, UQ Centre for Clinical Research, The University of Queensland, Herston, Qld 4029, Australia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scott A.","family":"Beatson","sequence":"additional","affiliation":[{"name":"BAustralian Infectious Diseases Research Centre, The University of Queensland, Brisbane, Qld 4072, Australia."},{"name":"CAustralian Centre for Ecogenomics, The University of Queensland, Brisbane, Qld 4072, Australia."},{"name":"DSchool of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, Qld 4072, Australia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Athena","family":"Limnios","sequence":"additional","affiliation":[{"name":"EWHO Collaborating Centre for STI and AMR, Microbiology Department, New South Wales Health Pathology, Prince of Wales Hospital, Sydney, NSW 2031, Australia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monica M.","family":"Lahra","sequence":"additional","affiliation":[{"name":"EWHO Collaborating Centre for STI and AMR, Microbiology Department, New South Wales Health Pathology, Prince of Wales Hospital, Sydney, NSW 2031, Australia."},{"name":"FSchool of Medical Sciences, UNSW, Sydney, NSW 2052, Australia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David M.","family":"Whiley","sequence":"additional","affiliation":[{"name":"AFaculty of Medicine, UQ Centre for Clinical Research, The University of Queensland, Herston, Qld 4029, Australia."},{"name":"BAustralian Infectious Diseases Research Centre, The University of Queensland, Brisbane, Qld 4072, Australia."},{"name":"GPathology Queensland, Microbiology Department, Herston, Qld 4029, Australia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian M.","family":"Forde","sequence":"additional","affiliation":[{"name":"BAustralian Infectious Diseases Research Centre, The University of Queensland, Brisbane, Qld 4072, Australia."},{"name":"CAustralian Centre for Ecogenomics, The University of Queensland, Brisbane, Qld 4072, Australia."},{"name":"DSchool of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, Qld 4072, Australia."},{"name":"HCorresponding author: Email: b.forde@uq.edu.au"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"67","published-online":{"date-parts":[[2019,9,4]]},"reference":[{"key":"2025102615522824000_R1","doi-asserted-by":"publisher","DOI":"10.1128\/microbiolspec.EI10-0009-2015","article-title":"Antimicrobial resistance expressed by Neisseria gonorrhoeae: a major global public health problem in the 21st century.","volume":"4","author":"Unemo","year":"2016","journal-title":"Microbiol Spectr"},{"key":"2025102615522824000_R2","unstructured":"Department of Health. Gonorrhoea health alert. Canberra: Australian Government; 2018. Available online at: https:\/\/www1.health.gov.au\/internet\/main\/publishing.nsf\/Content\/ohp-gonorrhoea.htm [verified 25 August 2019]."},{"key":"2025102615522824000_R3"},{"key":"2025102615522824000_R4","doi-asserted-by":"publisher","first-page":"735","DOI":"10.3201\/eid2404.171873","article-title":"Cooperative recognition of internationally disseminated ceftriaxone-resistant Neisseria gonorrhoeae strain.","volume":"24","author":"Lahra","year":"2018","journal-title":"Emerg Infect Dis"},{"key":"2025102615522824000_R5","doi-asserted-by":"publisher","first-page":"683","DOI":"10.1099\/jmm.0.007641-0","article-title":"Two cases of failed ceftriaxone treatment in pharyngeal gonorrhoea verified by molecular microbiological methods.","volume":"58","author":"Tapsall","year":"2009","journal-title":"J Med Microbiol"},{"key":"2025102615522824000_R6","doi-asserted-by":"crossref","first-page":"19792","DOI":"10.2807\/ese.16.06.19792-en","article-title":"Ceftriaxone treatment failure of pharyngeal 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ceftriaxone verified in Slovenia, September 2011.","volume":"17","author":"Unemo","year":"2012","journal-title":"Euro Surveill"},{"key":"2025102615522824000_R10","doi-asserted-by":"publisher","first-page":"20862","DOI":"10.2807\/1560-7917.ES2014.19.30.20862","article-title":"Four treatment failures of pharyngeal gonorrhoea with ceftriaxone (500 mg) or cefotaxime (500 mg), Sweden, 2013 and 2014.","volume":"19","author":"Golparian","year":"2014","journal-title":"Euro Surveill"},{"key":"2025102615522824000_R11"},{"key":"2025102615522824000_R12","doi-asserted-by":"publisher","first-page":"617","DOI":"10.1186\/s12879-017-2707-z","article-title":"Overall low extended-spectrum cephalosporin resistance but high azithromycin resistance in Neisseria gonorrhoeae in 24 European countries, 2015.","volume":"17","author":"Cole","year":"2017","journal-title":"BMC Infect 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