Drug-Resistant Gonorrhea Rising in Europe, ECDC Warns

Drug-Resistant Gonorrhea Rising in Europe, ECDC Warns

Health authorities in Europe are sounding the alarm over a sharp increase in gonorrhoea infections resistant to ceftriaxone, the primary antibiotic used as a first-line treatment for the infection. A risk assessment published by the European Centre for Disease Prevention and Control (ECDC) details an evolving epidemiological situation where cases once primarily tied to international travel are now spreading domestically across multiple nations.

The assessment, which draws on reports from 11 countries — Austria, Croatia, Denmark, France, Germany, Ireland, the Netherlands, Norway, Spain, Sweden, and the United Kingdom — indicates that the number of ceftriaxone-resistant Neisseria gonorrhoeae cases has surged since 2022. This include strains classified as multidrug-resistant (MDR) and extensively drug-resistant (XDR).

While early detections were associated with importation from regions with higher circulation of resistant strains, particularly from South-East Asia, that pattern is shifting. Data from 2025–2026 shows growing evidence of domestic transmission within the UK and the EU/EEA, with notable increases reported in Germany, Sweden, France, and the United Kingdom.

"Local transmission of ceftriaxone-resistant gonorrhoea in Europe is a warning sign we should not ignore,"

Csaba Ködmön, ECDC microbiology expert, via ecdc.europa.eu

The urgency of the warning follows a record-breaking year for the infection. In 2024, more than 106,000 confirmed gonorrhoea cases were recorded across the EU/EEA, the highest notification level since EU surveillance began in 2009. Globally, the bacterial infection is estimated to cause 82 million reported infections annually.

Risk Profiles and Complications

The ECDC stratifies the current threat based on behavior and travel. For the general sexually active population in the EU/EEA who do not engage in high-risk behaviors, the overall risk remains low. However, the risk is categorized as low-to-moderate for those with multiple or frequently changing partners and those having condomless sex with new or casual partners.

The risk is assessed as moderate for individuals living in the EU/EEA who travel to high-prevalence areas, such as South-East Asia, and engage in higher-risk sexual behaviors. These high-circulation regions remain the main route for introducing resistant strains into Europe.

Medical experts warn that if left untreated, the infection can cause severe health complications, including ectopic pregnancy, infertility, and pelvic inflammatory disease. The rise of resistance is particularly concerning because it threatens to erode current treatment options. The ECDC warns that the effectiveness of recommended regimens, ceftriaxone monotherapy or ceftriaxone combined with azithromycin, could be substantially reduced if MDR/XDR strains become established.

Global Resistance Trends

The European surge mirrors a broader global trend reported by the World Health Organization (WHO) through its Enhanced Gonococcal Antimicrobial Surveillance Programme (EGASP). Between 2022 and 2024, resistance to cefixime rose from 1.7% to 11%, and resistance to ceftriaxone rose from 0.8% to 5%.

Other antibiotic resistance levels reported by the WHO include:

• Ciprofloxacin: 95% resistance.
• Azithromycin: Stable at 4% resistance.

The WHO reported that Cambodia and Viet Nam have the highest resistance rates. In 2024, 12 EGASP countries, including Brazil, India, Indonesia, Malawi, the Philippines, Qatar, South Africa, Sweden, Thailand, Uganda, and Viet Nam, reported 3,615 cases. Of the symptomatic cases in men, 52% were from the WHO Western Pacific Region.

Preventative Measures and Future Outlook

Despite the rise in resistance, the ECDC notes that all documented infections to date have been successfully treated. To prevent further escalation, the agency recommends that healthcare providers prioritize antimicrobial susceptibility testing and that public health authorities strengthen surveillance and clinical management.

Prevention remains straightforward. Authorities urge the correct and consistent use of condoms or barrier methods, regular testing, especially after sex with new or multiple partners, and immediate testing following possible exposure.

Looking forward, the WHO is coordinating with its Collaborating Centre on AMR in STI in Sweden to conduct studies on tetracycline resistance and new treatments, such as gepotidacin and zoliflodacin. These efforts, along with doxycycline-based prevention (DoxyPEP) strategies, are intended to guide future control measures. India has begun implementation and data reporting as of 2025 under its National AIDS and Sexually Transmitted Diseases Control Programme.