{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T13:44:05Z","timestamp":1785851045927,"version":"3.56.0"},"reference-count":10,"publisher":"BMJ","issue":"5","funder":[{"name":"Ken Shimuta","award":["AMED\/JP24fk0108663j"],"award-info":[{"award-number":["AMED\/JP24fk0108663j"]}]},{"name":"Ken Shimuta","award":["JSPS KAKENHI\/JP24K12522"],"award-info":[{"award-number":["JSPS KAKENHI\/JP24K12522"]}]},{"name":"Yukihiro Akeda","award":["AMED \/JP 24fk0108697"],"award-info":[{"award-number":["AMED \/JP 24fk0108697"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Sex Transm Infect"],"accepted":{"date-parts":[[2025,11,2]]},"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>\n                      The presence of gonococcal strains carrying the\n                      <jats:italic>penA<\/jats:italic>\n                      -60.001 allele has been reported worldwide. These strains can be resistant to ceftriaxone (CRO), which often leads to treatment failure. However, this strain has not been reported in Japan since 2017; therefore, its recent spread is not understood. Here, we report the emergence of CRO-resistant\n                      <jats:italic>Neisseria gonorrhoeae<\/jats:italic>\n                      and the strain carrying the\n                      <jats:italic>penA<\/jats:italic>\n                      -60.001 allele in Japan in recent years.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      <jats:italic>N. gonorrhoeae<\/jats:italic>\n                      strains were identified during routine surveillance in the Kyoto\u2013Osaka area of Japan between 2018 and 2024. Antimicrobial susceptibility testing was performed using the agar dilution method. Whole-genome sequencing (WGS) was performed using the MiSeq platform. A phylogenetic tree was constructed based on the core genome using IQ-TREE V.2.0.0, with the best-fit nucleotide substitution model being selected using the Bayesian information criterion. Transformation experiments were conducted to confirm that the gDNA of the CRO-resistant strain of\n                      <jats:italic>N. gonorrhoeae<\/jats:italic>\n                      could generate a new CRO-resistant strain.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of the 1336\n                      <jats:italic>N<\/jats:italic>\n                      .\n                      <jats:italic>gonorrhoeae<\/jats:italic>\n                      strains isolated in this study, 6 were resistant to CRO. WGS revealed that one of these CRO-resistant\n                      <jats:italic>N. gonorrhoeae<\/jats:italic>\n                      strains, IW642, exhibited multilocus sequence type (MLST) 9903. It also carried the\n                      <jats:italic>penA<\/jats:italic>\n                      -60.001. A similarity analysis of the\n                      <jats:italic>penA-murE<\/jats:italic>\n                      regions of IW642 and FC428 revealed complete sequence identity in the\n                      <jats:italic>penA<\/jats:italic>\n                      region. Through transformation experiments, we also demonstrated the ability of IW642 gDNA to produce new CRO-resistant strains of\n                      <jats:italic>N. gonorrhoeae<\/jats:italic>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>\n                      An\n                      <jats:italic>N. gonorrhoeae<\/jats:italic>\n                      strain carrying the\n                      <jats:italic>penA<\/jats:italic>\n                      -60.001 allele was identified in Japan again, after not being reported since 2017. Based on a phylogenetic analysis, the strain originated from a different lineage than that of the previously dominant MLST 1903 strain in Japan. Transformation studies showed that new CRO-resistant\n                      <jats:italic>N. gonorrhoeae<\/jats:italic>\n                      strains could emerge from the gDNA of the MLST 9903 strain that was isolated.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/sextrans-2025-056694","type":"journal-article","created":{"date-parts":[[2025,11,20]],"date-time":"2025-11-20T19:00:21Z","timestamp":1763665221000},"page":"325-328","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Emergence of a ceftriaxone-resistant\n                    <i>Neisseria gonorrhoeae<\/i>\n                    strain harbouring\n                    <i>penA<\/i>\n                    -60.001 in a novel genetic background (MLST 9903) in Japan, 2018\u20132024"],"prefix":"10.1136","volume":"102","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1416-4116","authenticated-orcid":false,"given":"Ken","family":"Shimuta","sequence":"first","affiliation":[{"name":"National Institute of Infectious Diseases, Japan Institute for Health Security, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuki","family":"Ohama","sequence":"additional","affiliation":[{"name":"National Institute of Infectious Diseases, Japan Institute for Health Security, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ai","family":"Yoshida","sequence":"additional","affiliation":[{"name":"National Institute of Infectious Diseases, Japan Institute for Health Security, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shu-ichi","family":"Nakayama","sequence":"additional","affiliation":[{"name":"National Institute of Infectious Diseases, Japan Institute for Health Security, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Makoto","family":"Ohnishi","sequence":"additional","affiliation":[{"name":"National Institute of Infectious Diseases, Japan Institute for Health Security, Tokyo, Japan"},{"name":"Okinawa Prefectural Institute of Health and Environment, Okinawa, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3336-4188","authenticated-orcid":false,"given":"Takuya","family":"Kawahata","sequence":"additional","affiliation":[{"name":"Osaka Institute of Public Health, Osaka, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hideyuki","family":"Takahashi","sequence":"additional","affiliation":[{"name":"National Institute of Infectious Diseases, Japan Institute for Health Security, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yukihiro","family":"Akeda","sequence":"additional","affiliation":[{"name":"National Institute of Infectious Diseases, Japan Institute for Health Security, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,11,20]]},"reference":[{"key":"2026071602100839000_102.5.325.1","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1038\/s41572-019-0128-6","article-title":"Gonorrhoea","volume":"5","author":"Unemo","year":"2019","journal-title":"Nat Rev Dis Primers"},{"key":"2026071602100839000_102.5.325.2","doi-asserted-by":"crossref","first-page":"152","DOI":"10.1093\/infdis\/jiaf008","article-title":"Emergence of Ceftriaxone-Resistant Neisseria gonorrhoeae Through Horizontal Gene Transfer Among Neisseria Species","volume":"232","author":"Shimuta","year":"2025","journal-title":"J Infect Dis"},{"key":"2026071602100839000_102.5.325.3","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dkae369"},{"key":"2026071602100839000_102.5.325.4","doi-asserted-by":"crossref","first-page":"1683","DOI":"10.3201\/eid3008.240139","article-title":"Surge in Ceftriaxone-Resistant Neisseria gonorrhoeae FC428-Like Strains, Asia-Pacific Region, 2015\u22122022","volume":"30","author":"Xiu","year":"2024","journal-title":"Emerg Infect Dis"},{"key":"2026071602100839000_102.5.325.5","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.00504-16"},{"key":"2026071602100839000_102.5.325.6","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dkz129"},{"key":"2026071602100839000_102.5.325.7","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dkae176"},{"key":"2026071602100839000_102.5.325.8","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dkac158"},{"key":"2026071602100839000_102.5.325.9","doi-asserted-by":"crossref","first-page":"2854","DOI":"10.1093\/jac\/dkae297","article-title":"High-level ceftriaxone resistance due to transfer of penA allele 60.001 into endemic gonococcal lineages in Hangzhou, China","volume":"79","author":"Yang","year":"2024","journal-title":"J Antimicrob Chemother"},{"key":"2026071602100839000_102.5.325.10","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1016\/j.jgar.2019.02.011","article-title":"A real-time PCR assay for detecting a penA mutation associated with ceftriaxone resistance in Neisseria gonorrhoeae","volume":"19","author":"Shimuta","year":"2019","journal-title":"J Glob Antimicrob Resist"}],"container-title":["Sexually Transmitted Infections"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/sextrans-2025-056694","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T09:10:31Z","timestamp":1784193031000},"score":1,"resource":{"primary":{"URL":"https:\/\/sti.bmj.com\/lookup\/doi\/10.1136\/sextrans-2025-056694"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,20]]},"references-count":10,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2026,7,16]]},"published-print":{"date-parts":[[2026,8]]}},"alternative-id":["10.1136\/sextrans-2025-056694"],"URL":"https:\/\/doi.org\/10.1136\/sextrans-2025-056694","relation":{},"ISSN":["1368-4973","1472-3263"],"issn-type":[{"value":"1368-4973","type":"print"},{"value":"1472-3263","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,20]]}}}