Ceftriaxone-Resistant Gonorrhea — China, 2022

Results

In 2022, a total of 2,804 isolates (4.1% of 68,217 gonococcal infection cases) from 13 provinces in China were tested for antimicrobial susceptibility. The largest numbers of cases were reported in Guangdong (22,171) and Zhejiang (13,460) provinces. Rates of reported cases ranged from 2.13 to 20.58 per 100,000 population, with highest rates reported in Zhejiang, Guangdong, Yunnan, Hainan, and Guangxi provinces (Table 1).

Percentages of isolates tested by province ranged from 2.1% (Yunnan) to 18.1% (Tianjin). Among isolates submitted, resistance was identified to ciprofloxacin (97.6%), penicillin (77.8%), tetracycline (77.1%), azithromycin (16.9%), cefixime (16.0%), and ceftriaxone (8.1%) (Table 2). Only one isolate was resistant to spectinomycin. Among 2,804 isolates, those from 18 cases were identified as resistant to all antibiotics except spectinomycin.

Antibiotic resistance rates differed among provinces. Whereas ceftriaxone resistance detected in most sentinel sites was ≤5% during the past decade, in 2022, five provinces (Chongqing, Jiangsu, Sichuan, Tianjin, and Xinjiang) reported >10% ceftriaxone resistance, with rates in Sichuan, Tianjin, and Xinjiang surpassing 20%; only Hainan, Hunan, Shanghai, and Zhejiang reported ≤5% ceftriaxone resistance (Figure). Among other antibiotics, overall resistance to cefixime was 16.0%, with rates in Jiangsu, Sichuan, Tianjin, and Xinjiang exceeding 25%. Azithromycin resistance was >35% in Hunan and Shanghai and >20% in Chongqing, Guangdong, Tianjin, and Xinjiang. Resistance to ciprofloxacin remained consistently high nationwide (97.6%), with Hunan, Shaanxi, Shanghai, Sichuan, Tianjin, and Yunnan reaching 100%. Overall resistance to tetracycline was 77.1%, ranging from 28.3% in Tianjin to 100% in Xinjiang. Penicillin resistance was 77.8% nationwide and was >70% in most provinces; the highest penicillin resistance rate (98.2%) was reported by Shanghai province.