{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T21:54:59Z","timestamp":1781906099789,"version":"3.54.5"},"reference-count":11,"publisher":"SAGE Publications","issue":"8","license":[{"start":{"date-parts":[[2026,3,30]],"date-time":"2026-03-30T00:00:00Z","timestamp":1774828800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Int J STD AIDS"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>\n                      Ceftriaxone is currently the most frequently recommended first-line therapy for gonorrhoea globally. The emergence of ceftriaxone-resistant\n                      <jats:italic toggle=\"yes\">Neisseria gonorrhoeae<\/jats:italic>\n                      threatens effective control, yet longitudinal surveillance data remain limited in many settings. Sentinel gonococcal antimicrobial resistance surveillance has been conducted at the Department of STI Control (DSC), Singapore, since 2014. We report findings on the emergence of ceftriaxone-resistant\n                      <jats:italic toggle=\"yes\">Neisseria gonorrhoeae<\/jats:italic>\n                      detected between 2018 and 2025.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We conducted an analysis of longitudinal sentinel laboratory surveillance data from January 2018 to October 2025.\n                      <jats:italic toggle=\"yes\">Neisseria gonorrhoeae<\/jats:italic>\n                      isolates underwent culture and antimicrobial susceptibility testing using gradient diffusion method (Etest) at the Department of Microbiology, Singapore General Hospital. Isolates with ceftriaxone minimum inhibitory concentrations \u22650.25\u00a0mg\/L were identified using European Committee on Antimicrobial Susceptibility Testing criteria. Clinical, behavioural and treatment outcome data were extracted from electronic medical records.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 2695\n                      <jats:italic toggle=\"yes\">Neisseria gonorrhoeae<\/jats:italic>\n                      isolates tested, 23 (0.85%) ceftriaxone-resistant isolates were identified. No ceftriaxone-resistant isolates were detected prior to 2018, and annual detection varied without a consistent upward trend. Median patient age was 35\u00a0years (IQR 24-48). The earliest case was a female patient involved in transactional sex work with pharyngeal infection; subsequent cases occurred exclusively among heterosexual individuals, predominantly men with urethral infection. Exposure through encounters involving paid sex as well as the absence of condom use during oral sex, were common. Most infections resolved following treatment with ceftriaxone 500\u00a0mg intramuscularly, although persistent pharyngeal infection was observed in one case.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>\n                      Ceftriaxone-resistant\n                      <jats:italic toggle=\"yes\">Neisseria gonorrhoeae<\/jats:italic>\n                      has been detected in Singapore since 2018 through sentinel surveillance. Continued culture-based antimicrobial resistance surveillance, incorporation of extragenital testing, and prioritisation of test-of-cure for pharyngeal infection are essential to support early detection, guide empirical therapy and inform clinical and public health responses.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/09564624261440693","type":"journal-article","created":{"date-parts":[[2026,3,30]],"date-time":"2026-03-30T17:37:27Z","timestamp":1774892247000},"page":"833-838","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Ceftriaxone-resistant\n                    <i>Neisseria gonorrhoeae<\/i>\n                    in Singapore: Eight years of sentinel surveillance"],"prefix":"10.1177","volume":"37","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6823-1647","authenticated-orcid":false,"given":"Ren Jie","family":"Tsai","sequence":"first","affiliation":[{"name":"National Skin Centre"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4900-6572","authenticated-orcid":false,"given":"Linus","family":"Cheng","sequence":"additional","affiliation":[{"name":"National Skin Centre"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ai Ling","family":"Tan","sequence":"additional","affiliation":[{"name":"Singapore General Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4686-3835","authenticated-orcid":false,"given":"Benson Koon Wee","family":"Yeo","sequence":"additional","affiliation":[{"name":"National Skin Centre"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,3,30]]},"reference":[{"key":"e_1_3_8_2_2","volume-title":"Global progress report on HIV, viral hepatitis and sexually transmitted infections, 2021","author":"World Health Organization","year":"2021","unstructured":"World Health Organization. Global progress report on HIV, viral hepatitis and sexually transmitted infections, 2021. World Health Organization, 2021."},{"key":"e_1_3_8_3_2","doi-asserted-by":"publisher","DOI":"10.1128\/CMR.00010-14"},{"key":"e_1_3_8_4_2","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-158-5-201303050-00004"},{"key":"e_1_3_8_5_2","first-page":"2514","article-title":"Gonorrhoea treatment failure caused by a resistant strain with enhanced transmission","volume":"392","author":"Eyre DW","year":"2018","unstructured":"Eyre DW, Sanderson ND, Lord E, et al. Gonorrhoea treatment failure caused by a resistant strain with enhanced transmission. Lancet 2018; 392: 2514\u20132525.","journal-title":"Lancet"},{"key":"e_1_3_8_6_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.02624-18"},{"key":"e_1_3_8_7_2","volume-title":"Chapter 5 \u2013 blood-borne and sexually transmitted diseases","author":"Ministry of Health Singapore","year":"2019","unstructured":"Ministry of Health Singapore. Chapter 5 \u2013 blood-borne and sexually transmitted diseases. : Ministry of Health Singapore, 2019 and 2020. [updated December 2025]. https:\/\/isomer-user-content.by.gov.sg\/18\/ef5116ec-d564-4c01-ab5e-d8eb0e3e7f6f\/Chapter5-BloodborneandSexuallyTransmittedDiseases2019and2020_UpdatedwithDec2025c.pdf 2025. Available from."},{"key":"e_1_3_8_8_2","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dkv321"},{"key":"e_1_3_8_9_2","doi-asserted-by":"publisher","DOI":"10.2807\/1560-7917.ES.2022.27.46.2200803"},{"key":"e_1_3_8_10_2","doi-asserted-by":"publisher","DOI":"10.3201\/eid1701.100397"},{"key":"e_1_3_8_11_2","doi-asserted-by":"publisher","DOI":"10.47102\/annals-acadmedsg.2025240"},{"key":"e_1_3_8_12_2","first-page":"1061","article-title":"Gepotidacin versus ceftriaxone plus azithromycin for the treatment of uncomplicated urogenital gonorrhea (EAGLE-1): a randomised, multicentre, open-label, non-inferiority, phase 3 trial","volume":"402","author":"Taylor SN","year":"2023","unstructured":"Taylor SN, Marrazzo J, Batteiger BE, et al. Gepotidacin versus ceftriaxone plus azithromycin for the treatment of uncomplicated urogenital gonorrhea (EAGLE-1): a randomised, multicentre, open-label, non-inferiority, phase 3 trial. Lancet 2023; 402: 1061\u20131070.","journal-title":"Lancet"}],"container-title":["International Journal of STD &amp; AIDS"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/09564624261440693","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/09564624261440693","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/09564624261440693","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T21:48:44Z","timestamp":1781905724000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/09564624261440693"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,30]]},"references-count":11,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2026,7]]}},"alternative-id":["10.1177\/09564624261440693"],"URL":"https:\/\/doi.org\/10.1177\/09564624261440693","relation":{},"ISSN":["0956-4624","1758-1052"],"issn-type":[{"value":"0956-4624","type":"print"},{"value":"1758-1052","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,30]]}}}