Could tolerance explain an individual’s eight episodes of gonococcal treatment failure with ceftriaxone? A case report

Objectives Describe the clinical evolution of a person with recurrent gonococcal cervicitis despite appropriate treatment and lack of reinfection.Methods We used the tolerance detection test to confirm that all three culture-positive gonococcal isolates were tolerant to ceftriaxone.Results Over a period of 6 months, a transgender man with gonococcal cervicitis experienced eight episodes of treatment failure despite receiving ceftriaxone 1 g intramuscularly on each occasion. The isolate remained susceptible to ceftriaxone throughout this period. His Neisseria gonorrhoeae infection was then successfully eradicated with a prolonged course of ceftriaxone.Conclusions We propose that bacterial tolerance be considered a possible cause of treatment failure in N. gonorrhoeae. A tolerance detection test can be used to diagnose tolerance.