Table 2 List of N. gonorrhoeae genetic antimicrobial resistance (AMR) determinants in Pathogenwatch. References that report evidence of association of each mechanism with AMR in clinical isolates and/or where their role on AMR has been confirmed in the laboratory through, e.g. transformation experiments, are included in the table. Effect: R = resistance, I = susceptibility but increased exposure, A = additive effect, N = negative effect. R and I follow the EUCAST clinical breakpoints except for azithromycin, for which the epidemiological cut-off (ECOFF) is reported and used instead

Azithromycin

(R: MIC>1, ECOFF)

23S rDNA 2045A>G substitution (2059A>G in E. coli)

R

[75]

23S rDNA 2597C>T substitution (2611C>T in E. coli)

R

[88]

ermA, ermB, ermC, ermF genes

R

[89, 90]

ereA, ereB genes

R

[22]

mefA gene

R

[90, 91]

macAB promoter -48G>T substitution^a

R

[92]

 N. meningitidis-like mosaic (n = 1)

R

[23]

 N. lactamica-like mosaic (n = 2)

R

[23]

 N. meningitidis-like mosaic (n = 1)

R

[23]

 N. lactamica-like mosaic (n = 2)

R

[23]

mtrR promoter -57delA^a

A

[93, 94]

mtrR G45D

A

[95, 96]

mtrC loss-of-function

N

[26]

rplV ARAK tandem duplication (position 90)

R

[18]

rplV KGPSLK tandem duplication (position 83)

R

[18]

rplD G70D

A

[25]

Ceftriaxone^c

(R: MIC>0.125)

penA mosaic (A311V, I312M, V316P/T, T483S and G545S)

R

[97, 98, 100]

penA V316P, T483S, A501P/V, G542S

R

[97, 100]

rpoB P157L, G158V, R201H

R

[21]

rpoD D92–95 deletion, E98K

I

[21]

Cefixime^c

(R: MIC>0.125)

mtrR G45D

A

[95, 96]

penA mosaic (I312M, V316T, G545S)

R

[97, 98, 100]

penA mosaic (A311V, I312M, V316P/T, T483S and G545S)

R

[97, 98, 100]

penA V316P, T483S, A501P

I

[97, 100]

rpoB P157L, G158V, R201H

I

[21]

rpoD D92-95 deletion, E98K

I

[21]

Ciprofloxacin

(I: 0.03<MIC≤0.06;

R: MIC>0.06)

gyrA S91F, D95A/N

R

[99]

gyrA D95G

I

[99]

norM promoter -7A>G, -104C>T substitutions^a

I

[101]

parC D86N, S87R

R

[99]

parC S87I/N, S88P, E91K

I

[99]

parE G410V

I

[102]

Tetracycline^d

(I: 0.5<MIC≤1;

R: MIC>1)

mtrR A39T, G45D

A

[95, 96]

mtrR loss-of-function

I

[22]

mtrR promoter -56A>C substitution, -57delA deletion^a

I

[23, 93, 94]

mtrR promoter -131G>A (mtrC -120G>A substitution, mtr120)^a

I

[95]

rpsJ V57M

I

[103]

tetM gene

R

[104]

Penicillins

(I: 0.06<MIC≤1;

R: MIC>1)

blaTEM gene

R

[105]

mtrR G45D

I

[95, 96]

mtrR A39T

A

[95]

mtrR loss-of-function

I

[22]

mtrR promoter -56A>C, -57delA^a

I

[23, 94]

mtrR promoter -131G>A (mtrC -120G>A substitution, mtr120)^a

I

[95]

penA I312M, V316P/T, ins346D, T483S, A501P/T/V, G542S, G545S, P551S

I

[97, 100]

penA mosaic (I312M, V316T, G545S)

A

[97, 98, 100]

ponA1 L421P

I

[106]

porB1b G120K, A121N/D

I

[107]

Spectinomycin

(R: MIC>64)

16S rDNA 1184C>T (1192C>T in E. coli)

R

[108]

rpsE T24P

R

[109]

rpsE V27- deletion, K28E

R/A

[109]

Sulfonamides^e

folP R228S

R

[22, 110]