ECDC warns of spread of ceftriaxone-resistant gonorrhoea across Europe

The European Centre for Disease Prevention and Control has confirmed local transmission of ceftriaxone-resistant gonorrhoea in several European countries, warning that narrowing treatment options could limit future care for one of the world's most common sexually transmitted infections

More European countries have been detecting strains of gonorrhoea that resist ceftriaxone – the first-line antibiotic used to treat the infection – according to a risk assessment issued by the European Centre for Disease Prevention and Control (ECDC). Evidence of the spread of these resistant strains since 2024, together with the wider prevalence of the infection, poses a significant challenge for future treatment options in one of the most common sexually transmitted infections (STIs) worldwide.

“Local transmission of ceftriaxone-resistant gonorrhoea in Europe is a warning sign we should not ignore,” said Dr. Csaba Ködmön, a microbiology expert at the ECDC.

“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,” he said.

The ECDC's risk assessment analysed the surge in ceftriaxone-resistant gonorrhoea infections across Europe since 2022 – together with the related risks for sexually active people – based on reports from 11 European countries.

According to the assessment, the overall risk posed by ceftriaxone-resistant gonorrhoea has remained low for the general sexually active population in the European Union (EU) and European Economic Area (EEA). The risk is raised, however, among those people who are having sex without a condom with casual or new partners, those with multiple or frequently changing sexual partners, sex workers and their clients, and those who travel to areas with a high prevalence of drug-resistant strains of the infection.

Early detections of ceftriaxone-resistant cases in Europe have been linked to its importation from areas with a higher circulation of such resistant strains, particularly South-East Asia which has remained the main route of introduction into the European region.

Gonorrhoea is one of the most common bacterial STIs in the world with an estimated 82 million infections reported each year. More than 106,000 confirmed cases of gonorrhoea were recorded across the EU/EEA in 2024, the highest notification level since European-wide surveillance began in 2009. If left untreated, the infection can lead to severe complications, which can include pelvic inflammatory disease, infertility or ectopic pregnancy.

Prevention of gonorrhoea remains straightforward, however, with the correct and consistent use of condoms or other barrier methods during sex, and regular testing for STIs – especially following sex with new, casual or multiple partners.

The ECDC has made several recommendations to public health authorities and healthcare providers, intended to address the risk and to maintain the effectiveness of current treatments for gonorrhoea. These include the continued surveillance of gonococcal antimicrobial resistance, antimicrobial susceptibility testing, effective clinical management and targeted prevention measures to limit the spread of the infection.

For further reading please visit: https://www.ecdc.europa.eu/en/news-events/bacterial-stis-reach-record-highs-europe-congenital-syphilis-cases-nearly-double