Clinical Neisseria gonorrhoeae isolates in the United States with resistance to azithromycin possess mutations in all 23S rRNA alleles and the mtrR coding region.

We identified strains of Neisseria gonorrhoeae in San Diego County, California, that possess high levels of resistance to azithromycin (8.0-16.0 mu g/ml MIC). These isolates contain a combination of mutations in both the 23S rRNA loci and mtrR genes. This is the first description of such isolates in the United States.