Rising Antibiotic Resistance in Gonorrhoea Sparks Global Health Alert

The World Health Organization has warned that gonorrhoea, a common sexually transmitted infection, is becoming increasingly resistant to the antibiotics used to treat it, raising fears of harder to treat infections worldwide.

New data from the WHO Enhanced Gonococcal Antimicrobial Surveillance Programme show a sharp rise in resistance to ceftriaxone and cefixime, the primary drugs recommended globally. The warning comes as the world marks Antimicrobial Resistance Awareness Week, underscoring the urgency of strengthening global defences against drug resistant infections.

“This global effort is essential to tracking, preventing, and responding to drug resistant gonorrhoea and to protecting public health worldwide,” said Dr Tereza Kasaeva, Director of the WHO Department for HIV, TB, Hepatitis and STIs. She urged countries to strengthen national STI programmes and integrate routine gonorrhoea surveillance.

Resistance rising fast

According to WHO, resistance to ceftriaxone rose from 0.8 percent in 2022 to 5 percent in 2024, while resistance to cefixime increased from 1.7 percent to 11 percent over the same period. Azithromycin resistance remained stable at 4 percent, but resistance to ciprofloxacin has reached an alarming 95 percent in some areas. Cambodia and Viet Nam reported the highest resistance levels.

The number of countries submitting surveillance data is also increasing. In 2024, twelve countries across five WHO regions provided reports, up from four in 2022, showing growing global commitment to track emerging threats. Countries reporting included Brazil, Cambodia, India, Indonesia, Malawi, the Philippines, Qatar, South Africa, Sweden, Thailand, Uganda and Viet Nam. In total, they recorded 3615 cases of gonorrhoea.

Where cases are concentrated

More than half of symptomatic infections in men, representing 52 percent, were reported in the WHO Western Pacific Region. The Philippines alone accounted for 28 percent of cases, followed by Viet Nam at 12 percent, Cambodia at 9 percent and Indonesia at 3 percent. African countries contributed 28 percent of all reported cases, followed by South East Asia at 13 percent, the Eastern Mediterranean at 4 percent and the Americas at 2 percent.

The median patient age was 27, with cases ranging from 12 to 94 years. Twenty percent of patients were men who have sex with men. Forty two percent reported multiple sexual partners in the previous month. Nearly one in five had recently travelled, and eight percent reported recent antibiotic use.

Expanding surveillance and testing new treatments

WHO also accelerated genomic surveillance in 2024, sequencing nearly 3000 samples from eight countries. The organisation, together with its Collaborating Centre in Sweden, conducted key studies on new drug candidates zoliflodacin and gepotidacin, as well as investigations into tetracycline resistance. These studies will help guide future treatment and prevention strategies, including the use of doxycycline based prevention.

EGASP continued to expand, with Brazil, Côte d’Ivoire and Qatar joining the network. India is expected to begin reporting in 2025 under its National AIDS and Sexually Transmitted Diseases Control Programme.

Challenges ahead

Despite progress, WHO warns that gaps persist. Limited funding, incomplete reporting and insufficient data from women and extragenital sites make it difficult to fully understand global resistance patterns. The agency is calling for urgent investment to strengthen national surveillance systems and ensure equitable access to diagnostics and new treatments.

Countries must act now, WHO stresses, to prevent drug resistant gonorrhoea from becoming an even more serious global health threat.