{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T03:15:39Z","timestamp":1777605339376,"version":"3.51.4"},"reference-count":10,"publisher":"BMJ","issue":"3","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Sex Transm Infect"],"accepted":{"date-parts":[[2025,8,13]]},"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Describe the clinical evolution of a person with recurrent gonococcal cervicitis despite appropriate treatment and lack of reinfection.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We used the tolerance detection test to confirm that all three culture-positive gonococcal isolates were tolerant to ceftriaxone.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Over a period of 6\u2009months, a transgender man with gonococcal cervicitis experienced eight episodes of treatment failure despite receiving ceftriaxone 1\u2009g intramuscularly on each occasion. The isolate remained susceptible to ceftriaxone throughout this period. His\n                      <jats:italic>Neisseria gonorrhoeae<\/jats:italic>\n                      infection was then successfully eradicated with a prolonged course of ceftriaxone.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>\n                      We propose that bacterial tolerance be considered a possible cause of treatment failure in\n                      <jats:italic>N. gonorrhoeae<\/jats:italic>\n                      . A tolerance detection test can be used to diagnose tolerance.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/sextrans-2025-056591","type":"journal-article","created":{"date-parts":[[2025,9,8]],"date-time":"2025-09-08T17:26:13Z","timestamp":1757352373000},"page":"179-181","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Could tolerance explain an individual\u2019s eight episodes of gonococcal treatment failure with ceftriaxone? A case report"],"prefix":"10.1136","volume":"102","author":[{"given":"Izumo","family":"Kanesaka","sequence":"first","affiliation":[{"name":"Department of Infection Control and Prevention, Faculty of Nursing, Toho University Faculty of Medicine Graduate School of Medicine, Ota, Tokyo, Japan"},{"name":"Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5541-6041","authenticated-orcid":false,"given":"Thibaut","family":"Vanbaelen","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1804-252X","authenticated-orcid":false,"given":"Irith","family":"De Baetselier","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dorien","family":"Van den Bossche","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Said","family":"Abdellati","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tessa","family":"de Block","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8421-5137","authenticated-orcid":false,"given":"Sheeba Santhini","family":"Manoharan-Basil","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2557-8998","authenticated-orcid":false,"given":"Chris","family":"Kenyon","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium"},{"name":"Medicine, University of Cape Town, Rondebosch, South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,9,8]]},"reference":[{"key":"2026041607151271000_102.3.179.1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jflm.2007.04.001"},{"key":"2026041607151271000_102.3.179.2","doi-asserted-by":"crossref","first-page":"e26","DOI":"10.1097\/OLQ.0000000000002141","article-title":"Case Report: Treatment of Gonorrhea in Setting of Ceftriaxone Allergy","volume":"52","author":"Morton","year":"2025","journal-title":"Sex Transm Dis"},{"key":"2026041607151271000_102.3.179.3","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2023-073068","article-title":"Impact of testosterone use on the vaginal microbiota of transgender men, including susceptibility to bacterial vaginosis: study protocol for a prospective, observational study","volume":"13","author":"Muzny","year":"2023","journal-title":"BMJ Open"},{"key":"2026041607151271000_102.3.179.4","doi-asserted-by":"crossref","first-page":"347","DOI":"10.1007\/s00404-024-07626-8","article-title":"The influence of the vaginal ecosystem on vaginitis, bacterial vaginosis, and sexually transmitted diseases: an epidemiological study and literature review","volume":"311","author":"Occhipinti","year":"2025","journal-title":"Arch Gynecol Obstet"},{"key":"2026041607151271000_102.3.179.5","doi-asserted-by":"publisher","DOI":"10.1086\/593336"},{"key":"2026041607151271000_102.3.179.6","first-page":"347","article-title":"Bacterial Vaginosis-Vaginal Polymicrobial Biofilms and Dysbiosis","volume":"120","author":"Swidsinski","year":"2023","journal-title":"Dtsch Arztebl Int"},{"key":"2026041607151271000_102.3.179.7","doi-asserted-by":"publisher","DOI":"10.1128\/IAI.73.4.1964-1970.2005"},{"key":"2026041607151271000_102.3.179.8","doi-asserted-by":"crossref","DOI":"10.3390\/pathogens13070538","article-title":"The Prevalence of Antibiotic Tolerance in Neisseria gonorrhoeae Varies by Anatomical Site","volume":"13","author":"Balduck","year":"2024","journal-title":"Pathogens"},{"key":"2026041607151271000_102.3.179.9","doi-asserted-by":"crossref","DOI":"10.3390\/antibiotics11111480","article-title":"Tolerance to Ceftriaxone in Neisseria gonorrhoeae: Rapid Induction in WHO P Reference Strain and Detection in Clinical Isolates","volume":"11","author":"Balduck","year":"2022","journal-title":"Antibiotics (Basel)"},{"key":"2026041607151271000_102.3.179.10","doi-asserted-by":"crossref","DOI":"10.3390\/antibiotics12030534","article-title":"Enolase Is Implicated in the Emergence of Gonococcal Tolerance to Ceftriaxone","volume":"12","author":"Manoharan-Basil","year":"2023","journal-title":"Antibiotics (Basel)"}],"container-title":["Sexually Transmitted Infections"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/sextrans-2025-056591","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T14:15:33Z","timestamp":1776348933000},"score":1,"resource":{"primary":{"URL":"https:\/\/sti.bmj.com\/lookup\/doi\/10.1136\/sextrans-2025-056591"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,8]]},"references-count":10,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026,4,16]]},"published-print":{"date-parts":[[2026,5]]}},"alternative-id":["10.1136\/sextrans-2025-056591"],"URL":"https:\/\/doi.org\/10.1136\/sextrans-2025-056591","relation":{},"ISSN":["1368-4973","1472-3263"],"issn-type":[{"value":"1368-4973","type":"print"},{"value":"1472-3263","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,8]]}}}