Background Neisseria gonorrhoeae infection is currently a serious medical problem for widespread of multi-drug resistant strains causing difficult to treat illnesses. Resistance to fluoroquinolones, azithromycin as well as recently reported cases of resistance to cefixime and ceftriaxone represents important health threat.

Methods The first consecutive isolates of Neisseria gonorrhoeae obtained from patients with risky sexual behaviour (promiscuity, commercial sex, gay community including HIV infected individuals) suspected of infection or carriage, coming to two dermatovenereology clinics in Prague from June 2012 to February 2013, were included. Strains were detected from clinical samples (urethral, vaginal/cervical, rectal or throat swabs) using standard culture technique. Susceptibility to fluoroquinolones and macrolides was routinely determined using disc diffusion test. E-test technique was done to establish MIC values of penicillin and cefixime. Clinical and epidemiological characteristics of patients and strains were studied using standardised protocol.

Results A total of 82 N. gonorrhoeae consecutive isolates were tested. The resistance rate to ciprofloxacin was 40%, resistance to erythromycin was 3.8%, respectively. Penicillin MIC equal or higher than 1.0g/l was found in 21% of strains. Cefixime MIC values were equal to 0.125g/l in 4.9% of strains, no strain with MIC higher than 0.125g/l was identified. The patients were treated with azithromycin, doxycycline, cefixime, ceftriaxone, penicillin or combinations of antibiotics. Treatment failure was observed in 7 cases. Association of treatment failure with antimicrobial resistance should be clarified via following clinical studies.

Conclusions Preliminary results confirmed important occurrence of resistance of N. gonorrhoeae to essential antimicrobials in high risk population in the Czech Republic. Similarly to other European countries, increasing MIC values of penicillin and cefixime indicate growing risk of difficult to treat N. gonorrhoeae infections.