<p>The effectiveness of treatment for gonorrhoea continues to be threatened by the development of resistance to the last-line treatment, ceftriaxone. The UK Health Security Agency’s (UKHSA) Gonococcal Resistance to Antimicrobials Surveillance Programme (GRASP) includes a suite of testing and surveillance systems to detect and monitor antimicrobial resistance in Neisseria gonorrhoeae and potential treatment failures. GRASP reports annually on drug resistance in Neisseria gonorrhoeae in England and Wales and has directly influenced changes in treatment guidelines on three occasions.</p><p>Additionally, all primary diagnostic laboratories test gonococcal isolates for susceptibility to ceftriaxone and refer suspected resistant isolates to the UKHSA national reference laboratory for confirmatory testing and follow-up in real-time. UKHSA has published guidance on managing cases of ceftriaxone-resistant gonorrhoea and performs a risk assessment for each case. If there is a risk of transmission within England, UKHSA instigates an Incident Response to contain spread.</p>