An increasing number of European countries have detected gonococcal strains resistant to the antibiotic ceftriaxone, the first-line drug to treat gonorrhea infection. And this poses a significant challenge for future treatment options for one of the most common sexually transmitted diseases worldwide, according to an assessment issued by the European Centre for Disease Prevention and Control (ECDC).
Local transmission of ceftriaxone-resistant gonorrhoea in Europe is a warning sign we should not ignore, says Csaba Ködmön, an ECDC microbiology expert.
“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. Strengthening prevention, expanding antimicrobial testing, and promoting timely diagnosis are therefore essential to detect resistant strains early, limit further spread, and keep gonorrhoea treatable,” says Ködmön.
In an ECDC risk assessment analyses, the surge in ceftriaxone-resistant gonorrhoea infections was noted across Europe since 2022, as well as related risks for sexually active people, based on reports from 11 European countries.
According to ECDC’s assessment, the overall risk posed by ceftriaxone-resistant gonorrhoea remains low for the general sexually active population in the European Union and European Economic Area (EU/EEA). It is higher among people having sex without a condom or other means of protection with casual or new partners, people with multiple or frequently changing sexual partners, sex workers and their clients, and for those travelling to areas with a high prevalence of drug-resistant strains of gonorrhoea.
Early detections of ceftriaxone-resistant cases in Europe have been associated with importation from areas with higher circulation of such resistant strains, particularly from South-East Asia. This remains the main route of introduction into Europe.
Gonorrhoea is one of the most common bacterial sexually transmitted infections (STI) globally, with an estimated 82 million reported infections each year. There were more than 106 000 confirmed gonorrhoea cases across the EU/EEA in 2024, the highest notification level since the start of EU surveillance in 2009. If left untreated, gonorrhoea infection can lead to severe complications, including pelvic inflammatory disease, infertility and ectopic pregnancy.
Prevention of gonorrhoea infection remains straightforward with correct and consistent use of condoms or other barrier methods when having sex, getting tested regularly especially after sex with new, casual or multiple sexual partners, and seeking testing after possible exposure.
ECDC makes several recommendations for public health authorities and healthcare providers to address the risk and maintain the effectiveness of current gonorrhoea treatments, including:
- continued surveillance of gonococcal antimicrobial resistance;
- antimicrobial susceptibility testing;
- effective clinical management; and
- targeted prevention measures to limit spread, including clear messages on safer sex, regular testing for those with new or casual partners, and timely treatment if symptoms appear or there has been potential exposure.
ECDC’s risk assessment is based on reports from: Austria, Croatia, Denmark, France, Germany, Ireland, the Netherlands, Norway, Spain, Sweden, and the United Kingdom.
Current European treatment guidelines recommend ceftriaxone-based therapy for gonorrhoea. However, over the past two decades, Neisseria gonorrhoeae has demonstrated a strong capacity to develop resistance to drugs widely used to treat STIs, including penicillins, fluoroquinolones, macrolides, and extended spectrum cephalosporins. This jeopardises effective treatment and control. The ECDC Response Plan provides a framework to strengthen antimicrobial resistance surveillance, clinical management and control measures.
