Abstract
Ceftriaxone resistance in Neisseria gonorrhoeae is an escalating global health concern, threatening the efficacy of empiric treatment. In the Asia-Pacific region, a rapid surge in ceftriaxone resistance has been observed, primarily associated with the penA-60.001 allele. This study, conducted in Hanoi, Vietnam between 2023 and 2024, analyzed 352 N. gonorrhoeae isolates and found a 27% prevalence of ceftriaxone resistance. Whole-genome sequencing identified that resistance was predominantly driven by the mosaic penA-237.001 allele, with a smaller contribution from penA-60.001. The high prevalence of resistance and the emergence of new alleles underscore the urgent threat to ceftriaxone as an empiric treatment option.