{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,23]],"date-time":"2026-04-23T06:36:14Z","timestamp":1776926174660,"version":"3.51.2"},"reference-count":27,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,4,23]],"date-time":"2026-04-23T00:00:00Z","timestamp":1776902400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cell. Infect. Microbiol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>\n                      Antibiotic tolerance slows bacterial killing during drug exposure without changing minimum inhibitory concentration (MIC) and is often missed by MIC-based testing in\n                      <jats:italic>Neisseria gonorrhoeae<\/jats:italic>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To quantify ceftriaxone tolerance using complementary laboratory assays and to integrate these readouts with genomic typing to interpret recurrent urethritis within one patient series.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Four clinical isolates obtained between 2022 and 2025 underwent tolerance disc testing. From the most recent isolate (25355), tolerant and non-tolerant variants were derived for functional study, including growth curves (log\n                      <jats:sub>10<\/jats:sub>\n                      CFU\/mL), minimum duration needed to kill 99% of cells (MDK99) across ceftriaxone concentrations, and a\n                      <jats:italic>Galleria mellonella<\/jats:italic>\n                      infection model. Whole-genome sequencing with in silico typing compared strain type between episodes.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Tolerance disc testing was positive for isolates 22073 and 25355. Across the growth trajectory, tolerant variants showed consistently lower bacterial counts than non-tolerant variants. Tolerant variants tended to exhibit longer MDK99 values, and in\n                      <jats:italic>Galleria<\/jats:italic>\n                      they declined more slowly under ceftriaxone exposure. Sequencing revealed distinct sequence types across episodes, supporting reinfection rather than within-host persistence.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Assays that capture killing kinetics detected ceftriaxone tolerance that was not captured by MIC-based testing. Genomic analysis distinguished reinfection from persistence. This integrated workflow may improve the evaluation of suspected treatment failure in gonorrhoea.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fcimb.2026.1720396","type":"journal-article","created":{"date-parts":[[2026,4,23]],"date-time":"2026-04-23T05:36:57Z","timestamp":1776922617000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Reinfection and ceftriaxone tolerance in a clinical case of recurrent gonorrhoea: a case report supported by in vitro and in vivo models"],"prefix":"10.3389","volume":"16","author":[{"given":"Izumo","family":"Kanesaka","sequence":"first","affiliation":[{"name":"Department of Clinical Sciences, Institute of Tropical Medicine Antwerp","place":["Antwerp, Belgium"]},{"name":"Department of Infection Control and Prevention, Faculty of Nursing, Toho University","place":["Tokyo, Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sa\u00efd","family":"Abdellati","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences, Institute of Tropical Medicine Antwerp","place":["Antwerp, Belgium"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thibaut","family":"Vanbaelen","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences, Institute of Tropical Medicine Antwerp","place":["Antwerp, Belgium"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Irith","family":"De Baetselier","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences, Institute of Tropical Medicine Antwerp","place":["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","place":["Antwerp, Belgium"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Basil","family":"Britto Xavier","sequence":"additional","affiliation":[{"name":"Department of Medical Microbiology and Infection Prevention, University Medical Center, Groningen, University of Groningen","place":["Groningen, Netherlands"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chris","family":"Kenyon","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences, Institute of Tropical Medicine Antwerp","place":["Antwerp, Belgium"]},{"name":"University of Cape Town","place":["Cape Town, South Africa"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sheeba Santhini","family":"Manoharan-Basil","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences, Institute of Tropical Medicine Antwerp","place":["Antwerp, Belgium"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,4,23]]},"reference":[{"key":"B1","unstructured":"FastQC: a quality control tool for high throughput sequence data\n          \n          \n            \n              Andrews\n              S.\n            \n          \n          \n          2010"},{"key":"B2","doi-asserted-by":"publisher","first-page":"2879","DOI":"10.1038\/s41467-021-23091-2","article-title":"A global resource for genomic predictions of antimicrobial resistance and surveillance of Salmonella Typhi at Pathogenwatch","volume":"12","author":"Argim\u00f3n","year":"2021","journal-title":"Nat. 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