Extensively drug-resistant (XDR) Neisseria gonorrhoeae cured with ceftriaxone 2 g intravenous monotherapy in Croatia, March 2026
We report the first extensively drug-resistant (XDR) gonorrhoea case in Croatia. In February 2026, a heterosexual male was diagnosed with gonorrhoea after unprotected vaginal intercourse with an unknown female in Croatia. Gonococcal isolate RI422 showed high-level azithromycin resistance, and resistance to ceftriaxone, cefixime, benzylpenicillin, ciprofloxacin and tetracycline. Mosaic penA-60.001 caused resistance to ceftriaxone and cefixime, and 23S rRNA A2045G mutations caused high-level azithromycin resistance. Ceftriaxone 2 g single-dose intravenously cured the infection. Notably, RI422 was susceptible [DG3.1]to zoliflodacin and gepotidacin.
We report the first extensively drug-resistant (XDR) gonorrhoea case in Croatia. In February 2026, a heterosexual male was diagnosed with gonorrhoea after unprotected vaginal intercourse with an unknown female in Croatia. Gonococcal isolate RI422 showed high-level azithromycin resistance, and resistance to ceftriaxone, cefixime, benzylpenicillin, ciprofloxacin and tetracycline. Mosaic penA-60.001 caused resistance to ceftriaxone and cefixime, and 23S rRNA A2045G mutations caused high-level azithromycin resistance. Ceftriaxone 2 g single-dose intravenously cured the infection. Notably, RI422 was susceptible [DG3.1]to zoliflodacin and gepotidacin.
Orebro University Hospital