Gonorrhea is the second most commonly diagnosed sexually transmitted infection (STI) in the United States. Rates of reported gonorrhea cases have increased by 111% since the historic low in 2009. Gonorrhea is caused by N. gonorrhoeae, a high-priority bacterial pathogen due to the increasing prevalence of antimicrobial-resistant strains. Nearly half of the new infections are estimated to be caused by antimicrobial-resistant strains. Understanding the transmission patterns and risk factors driving the increase in incidence and resistance is critical to developing effective intervention strategies and curbing the spread of N. gonorrhoeae, especially antimicrobial-resistant strains. To fulfill this research goal, we will have two aims. In aim 1, we will retrospectively enroll individuals who test positive for N. gonorrhoeae (N=100) in whom isolates (oral, genital, and/or rectal sites) are stored. We will extract demographics, medical history, medication for gonorrhea, treatment outcome, and sexual behavior from electronic health records and intake forms at the clinic. Cultures will undergo antimicrobial susceptibility testing and whole genome sequencing to identify isolates with impaired antimicrobial susceptibility, and phylogenetic analysis to identify groups of people with genetically similar N. gonorrhoeae strains. In aim 2, we will recruit 20 participants from aim 1 for an in-depth interview to develop feasible intervention strategies to promote routinely screening patients at high risk, identify those who had antimicrobial-resistant strains of infection, provide optimal treatment to curb the infection, and notify their partners of the potential exposure. This proposal builds upon an ongoing pilot project and advances the science of developing effective interventions to reduce the spread of N. gonorrhoeae, especially antibiotic-resistant strains. This study would be the first to link N. gonorrhoeae antimicrobial susceptibility, phylogenetic transmission clusters, and detailed sexual behavior histories at the local level to provide a model for larger studies and guidance for local and national efforts to prevent N. gonorrhoeae transmission.