In 2022, China reported 96,313 gonorrhea cases, making it the fourth most common notifiable infectious disease. Ceftriaxone resistance in Neisseria gonorrhoeae increased significantly, from 2.9% in 2017 to 8.1% in 2022, with five provinces reporting over 10% resistance. Resistance to other antibiotics was also high, with ciprofloxacin resistance at 97.6%, tetracycline at 77.1%, and penicillin at 77.8%. The China Gonococcal Resistance Surveillance Program (China-GRSP) collected 2,804 isolates from 13 provinces, representing 4.1% of all cases. The rise in ceftriaxone-resistant strains, particularly the FC428 clone, has been a major challenge. Effective diagnosis, treatment, and partner management are essential to prevent transmission. The findings highlight the urgent need for strategies like antibiotic stewardship to combat resistance. The study underscores the importance of continued surveillance and international collaboration to address the growing threat of antibiotic-resistant gonorrhea. Limitations include underreporting and limited surveillance coverage. Future research should focus on broader surveillance and understanding of sociodemographic factors. The results emphasize the dynamic nature of this public health issue and the need for adaptive, collaborative approaches.In 2022, China reported 96,313 gonorrhea cases, making it the fourth most common notifiable infectious disease. Ceftriaxone resistance in Neisseria gonorrhoeae increased significantly, from 2.9% in 2017 to 8.1% in 2022, with five provinces reporting over 10% resistance. Resistance to other antibiotics was also high, with ciprofloxacin resistance at 97.6%, tetracycline at 77.1%, and penicillin at 77.8%. The China Gonococcal Resistance Surveillance Program (China-GRSP) collected 2,804 isolates from 13 provinces, representing 4.1% of all cases. The rise in ceftriaxone-resistant strains, particularly the FC428 clone, has been a major challenge. Effective diagnosis, treatment, and partner management are essential to prevent transmission. The findings highlight the urgent need for strategies like antibiotic stewardship to combat resistance. The study underscores the importance of continued surveillance and international collaboration to address the growing threat of antibiotic-resistant gonorrhea. Limitations include underreporting and limited surveillance coverage. Future research should focus on broader surveillance and understanding of sociodemographic factors. The results emphasize the dynamic nature of this public health issue and the need for adaptive, collaborative approaches.