New data released today by the World Health Organization (WHO) highlight rising levels of drug-resistant gonorrhea.
The data from the WHO’s Enhanced Gonococcal Antimicrobial Surveillance Program (ESGAP) report show that resistance to ceftriaxone and cefixime—the two antibiotics currently recommended for first-line treatment—rose from 0.8% to 5% and from 1.7% to 11%, respectively, from 2022 to 2024. Resistance to azithromycin, which is often used in combination with ceftriaxone and cefixime to ensure successful treatment, rose from 0.5% to 4%, while 95% of Neisseria gonorrhoeae isolates were resistant to ciprofloxacin.
Rising resistant to ceftriaxone and cefixime are especially concerning given that the two antibiotics are the last remaining recommended treatment options for gonorrhea, a sexually transmitted infection (STI) that has quickly developed resistance to every antibiotic that’s been used for treatment. But there’s hope that two new antibiotics that have shown promise in clinical trials (zoliflodacin and gepotidacin) could soon provide more options.
The ESGAP data come from 12 countries in five WHO regions. The included countries—Brazil, Cambodia, India, Indonesia, Malawi, the Philippines, Qatar, South Africa, Sweden, Thailand, Uganda, and Vietnam—reported 3,615 gonorrhea cases in 2024. The highest resistance rates were in Cambodia and Vietnam.
An urgent public health threat
Gonorrhea is one the four most common STIs globally, with an estimated 82 million cases every year. Because of the limited treatment options, the WHO has labeled drug-resistant gonorrhea a serious and urgent public health threat. If untreated, gonorrhea can cause pelvic inflammatory disease, ectopic pregnancy (implantation of a fertilized egg outside the uterus), and infertility in women.
WHO officials say ESGAP data are critical to efforts to monitor the spread of drug-resistant gonorrhea.
“This global effort is essential to tracking, preventing, and responding to drug-resistant gonorrhoea and to protecting public health worldwide,” Tereza Kasaeva, MD, PhD, director of the WHO Department for HIV, TB, Hepatitis & STIs, said in a WHO press release. “WHO calls on all countries to address the rising levels of sexually transmitted infections (STIs) and integrate gonorrhoea surveillance into national STI programmes.”
