ECDC reports rise in drug-resistant gonorrhoea across Europe

Public health authorities are raising alarm over a tightening landscape for treating gonorrhoea, as drug-resistant strains of the infection continue to propagate across Europe. The European Centre for Disease Prevention and Control (Ecdc) warned that while the overall risk to the general population remains low, the emergence of domestic transmission within the European Union and the European Economic Area marks a concerning departure from previous patterns where cases were primarily tied to international travel.

The ECDC risk assessment, which analyzes surveillance reports from 11 countries, details the rise of strains resistant to ceftriaxone — a primary antibiotic currently relied upon for treatment. The shift toward locally acquired infections suggests that these resistant pathogens are becoming established within European borders.

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"Local transmission of ceftriaxone-resistant gonorrhoea in Europe is a warning sign we should not ignore. While the risk to the general population is currently low, growing resistance reduces the effectiveness of the therapies we rely on today. If highly drug-resistant strains become established and continue to spread, treatment options could become increasingly limited."

Csaba Ködmön, ECDC microbiology expert, via ECDC

Gonorrhoea, a common bacterial sexually transmitted infection, reached a significant milestone in 2024, when the EU/EEA recorded more than 106,000 confirmed cases, the highest notification level since regional surveillance began in 2009. The World Health Organization (Who) has labeled this global trend a serious public health threat, noting that if left untreated, the infection can lead to severe health complications, including pelvic inflammatory disease, ectopic pregnancy, and infertility.

Global Surveillance and Resistance Trends

The struggle to contain resistant strains extends far beyond Europe. Data from the Who’s Enhanced Gonococcal Antimicrobial Surveillance Programme (EGASP) demonstrates a sharp rise in resistance levels globally between 2022 and 2024. During this period, resistance to ceftriaxone rose from 0.8% to 5%, and resistance to cefixime climbed from 1.7% to 11%. Resistance to ciprofloxacin has reached 95%.

While the ECDC points to South-East Asia as a primary source of imported resistant strains, the WHO reports that the highest resistance rates were detected in Cambodia and Viet Nam. The data, provided by 12 countries, reflects a median patient age of 27, with 20% of cases involving men who have sex with men and 42% of patients reporting multiple sexual partners within the preceding month.

Risk Factors and Recommendations

The ECDC identifies specific groups at higher risk for encountering drug-resistant strains, including those who have sex without condoms, individuals with multiple or frequently changing partners, sex workers and their clients, and travelers to areas where such strains are prevalent. Health authorities advise that prevention remains straightforward, emphasizing the consistent use of barrier methods and the necessity of regular testing following potential exposure.

To combat the erosion of current treatment options, both the ECDC and the WHO are calling for:

• Increased funding and investment in national surveillance systems.
• Expansion of antimicrobial susceptibility testing to detect resistant strains early.
• Integration of gonorrhoea monitoring into broader national sexually transmitted infection programs.
• Development of clinical management strategies that address the narrowing effectiveness of current antibiotic regimens.

What to Watch Next

As current first-line treatments show signs of failure, eyes are turning toward the clinical pipeline. According to reporting from CIDRAP, two new antibiotics — zoliflodacin and gepotidacin, have shown promise in clinical trials and are being closely studied as potential future alternatives. Meanwhile, genomic surveillance remains a priority for the WHO, which sequenced nearly 3,000 samples across eight countries in 2024 to better understand the evolution of these bacteria.

For those living in or traveling to the EU/EEA, public health officials underscore the importance of maintaining vigilant diagnostic practices. The efficacy of the current ceftriaxone-based therapies may continue to fluctuate, necessitating ongoing updates to treatment guidelines as more surveillance data becomes available in the coming months.