Background As in other regions, rates of gonorrhea in North America continue to rise, while Neisseria gonorrhoeae (Ng) antimicrobial susceptibility, and particularly macrolide susceptibility, has declined. These patterns have heightened concerns about emerging resistance to the only remaining recommended treatment regimen and the prospect of untreatable gonorrhea.

Methods In this session, available data on Ng antimicrobial susceptibility trends in North America will be reviewed, with a focus on recent trends in cephalosporin, macrolide, and fluoroquinolone susceptibility. Public health responses, such as United States outbreak preparedness and response activities, will be explored.

Results Although the percentage of Ng isolates with reduced cephalosporin susceptibility has declined in recent years in the United States and Canada, the percentage with reduced azithromycin susceptibility has increased in both countries. High-level azithromycin resistant strains have been identified in the United States, and an isolate with a high ceftriaxone minimum inhibitory concentration (1 µg/ml) was identified in Canada (2017). Data from Mexico are limited. In addition to robust surveillance in the United States and Canada, the United States has implemented efforts to enhance rapid detection and response to Ng resistance.

Conclusions Robust surveillance and public health engagement are critical to address the growing threat of Ng resistance.