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BackgroundCeftriaxone is currently the most frequently recommended first-line therapy for gonorrhoea globally. The emergence of ceftriaxone-resistant <i>Neisseria gonorrhoeae</i> threatens effective control, yet longitudinal surveillance data remain limited in many settings. Sentinel gonococcal antimicrobial resistance surveillance has been conducted at the Department of STI Control (DSC), Singapore, since 2014. We report findings on the emergence of ceftriaxone-resistant <i>Neisseria gonorrhoeae</i> detected between 2018 and 2025.MethodsWe conducted an analysis of longitudinal sentinel laboratory surveillance data from January 2018 to October 2025. <i>Neisseria gonorrhoeae</i> isolates underwent culture and antimicrobial susceptibility testing using gradient diffusion method (Etest) at the Department of Microbiology, Singapore General Hospital. Isolates with ceftriaxone minimum inhibitory concentrations ≥0.25 mg/L were identified using European Committee on Antimicrobial Susceptibility Testing criteria. Clinical, behavioural and treatment outcome data were extracted from electronic medical records.ResultsAmong 2695 <i>Neisseria gonorrhoeae</i> isolates tested, 23 (0.85%) ceftriaxone-resistant isolates were identified. No ceftriaxone-resistant isolates were detected prior to 2018, and annual detection varied without a consistent upward trend. Median patient age was 35 years (IQR 24-48). The earliest case was a female patient involved in transactional sex work with pharyngeal infection; subsequent cases occurred exclusively among heterosexual individuals, predominantly men with urethral infection. Exposure through encounters involving paid sex as well as the absence of condom use during oral sex, were common. Most infections resolved following treatment with ceftriaxone 500 mg intramuscularly, although persistent pharyngeal infection was observed in one case.ConclusionCeftriaxone-resistant <i>Neisseria gonorrhoeae</i> has been detected in Singapore since 2018 through sentinel surveillance. Continued culture-based antimicrobial resistance surveillance, incorporation of extragenital testing, and prioritisation of test-of-cure for pharyngeal infection are essential to support early detection, guide empirical therapy and inform clinical and public health responses.