Trends and risk factors of antimicrobial resistance of Neisseria gonorrhoeae in Catalonia, Spain, 2022–2023

Neisseria gonorrhoeae (NG) remains a major cause of sexually transmitted infections (STIs) in Europe. Increasing antimicrobial resistance (AMR) threatens treatments’ effectiveness and complicates control efforts. Continuous regional surveillance is essential to detect emerging trends and inform public health action. To describe NG epidemiology and AMR trends in Catalonia during 2022–2023, and identify associated resistance risk factors. Retrospective analysis of laboratory-confirmed NG cases reported to the Microbiological Reporting System of Catalonia and the STI Registry. Antimicrobial susceptibility testing (AST) was performed for seven antibiotics. Descriptive analysis and logistic regression were used to assess associations between AMR and demographic and clinical variables, including age, sex, sexual orientation and gender identity (SOGI) and anatomical site of infection. 23,968 NG cases were reported, representing an 18.9% increase in incidence from 2022 to 2023. Culture was performed in 5,158 cases, AST results were available for 4,709 isolates. Resistance was highest for ciprofloxacin (71.4%) and tetracycline (48.9%), followed by azithromycin (20.3%) and penicillin (10.2%). Cefixime and ceftriaxone resistance was negligible. Azithromycin resistance was independently associated with homosexual orientation (adjusted odds ratio (aOR): 2.08) and anal infection (aOR: 1.41). Age ≥ 25 years was associated with resistance to ciprofloxacin, tetracycline, and penicillin. High NG incidence and substantial resistance to older antibiotics, together with notable azithromycin resistance, underscore the need for sustained AMR surveillance, particularly among men who have sex with men (MSM) and in anal infections. Strengthening culture-based AMR surveillance, extragenital screening and targeted prevention strategies are essential to preserve effective treatment options.