WHO Warns Drug-Resistant Gonorrhoea Rising Rapidly, Urges Global Action

WHO warns that if resistance continues to increase, gonorrhoea could become extremely difficult—or even impossible—to treat using existing medications.

The World Health Organization (WHO) has issued a serious warning that gonorrhoea, one of the world’s most common sexually transmitted infections (STIs), is becoming increasingly resistant to the antibiotics used to treat it. New findings from the agency’s Enhanced Gonococcal Antimicrobial Surveillance Programme (EGASP) show a sharp rise in resistance to several key drugs, raising fears of harder-to-treat infections and potential global spread.

The alarming trend comes during World Antimicrobial Resistance (AMR) Awareness Week, highlighting the urgency of tackling drug-resistant infections before they jeopardize decades of progress in public health.

Rapidly Rising Antibiotic Resistance

According to WHO’s new data covering 2022–2024, resistance to critical frontline antibiotics has risen dramatically:

• Ceftriaxone: 0.8% → 5%

• Cefixime: 1.7% → 11%

• Azithromycin: Stable at 4%

• Ciprofloxacin: 95% resistance

• Highest resistance rates reported in Cambodia and Viet Nam

Ceftriaxone and cefixime are the last widely effective treatments for gonorrhoea, making rising resistance a major cause for global concern. WHO warns that if resistance continues to increase, gonorrhoea could become extremely difficult—or even impossible—to treat using existing medications.

A Growing Surveillance Network

EGASP, launched in 2015, tracks gonorrhoea resistance globally by collecting laboratory and clinical data from designated sentinel sites. Participation is expanding rapidly:

• 12 countries submitted EGASP data in 2024

• Up from 4 countries in 2022

• Countries reporting include Brazil, Cambodia, India, Indonesia, Malawi, the Philippines, Qatar, South Africa, Sweden, Thailand, Uganda and Viet Nam

• A total of 3615 confirmed gonorrhoea cases were reported across these countries in 2024

This expansion marks growing global recognition of the threat posed by resistant STIs, though overall surveillance remains limited and patchy across many regions.

Geographic Distribution of Cases

More than half of symptomatic gonorrhoea cases in men (52%) were reported from WHO’s Western Pacific Region, including:

• Philippines – 28%

• Viet Nam – 12%

• Cambodia – 9%

• Indonesia – 3%

Other regions reporting cases:

• WHO African Region: 28%

• South-East Asia Region: 13% (Thailand)

• Eastern Mediterranean Region: 4% (Qatar)

• Americas: 2% (Brazil)

The data highlights substantial regional variation, with particularly intense transmission and drug resistance in Asia and Africa.

Demographic Trends Reflect High-Risk Transmission Networks

Among all reported cases:

• Median age: 27 years (range 12–94)

• 20% of patients were men who have sex with men

• 42% reported multiple sexual partners in the past 30 days

• 8% had used antibiotics recently

• 19% had travelled internationally

WHO says these findings underscore the importance of targeted prevention efforts, rapid diagnostic testing, and culturally sensitive sexual health services.

Advances in Genomic Surveillance and New Treatments

In 2024, WHO significantly advanced global genomic mapping of Neisseria gonorrhoeae:

• Nearly 3,000 samples genetically sequenced from 8 countries

• Studies conducted on:

  • Zoliflodacin

  • Gepotidacin

  • New tetracycline resistance pathways

• Research led by WHO’s Collaborating Centre on AMR in STIs in Sweden

These studies are shaping the next generation of treatment guidelines and informing global prevention strategies, including the use of doxycycline post-exposure prophylaxis (DoxyPEP).

Programme Expansion and Commitments

In 2024:

• Brazil, Côte d’Ivoire and Qatar joined EGASP

• India began implementation and will start reporting official data in 2025 under its national HIV/STI programme

WHO celebrates these additions as milestones but warns that participation still remains limited relative to global STI burden.

Persistent Gaps and Urgent Need for Investment

Despite progress, EGASP still faces significant obstacles:

• Limited and inconsistent funding

• Incomplete or delayed reporting

• Underrepresentation of women and extragenital infection sites

• Weak national surveillance in many low-resource settings

• Insufficient diagnostic capacities

WHO is calling for major new investment to expand surveillance networks, improve laboratory capability, and ensure equitable access to new and effective treatments as they become available.

A Global Call to Action

Dr Tereza Kasaeva, WHO Director for HIV, TB, Hepatitis & STIs, urged governments to take decisive action:

“This global effort is essential to tracking, preventing, and responding to drug-resistant gonorrhoea and protecting public health worldwide. WHO calls on all countries to address rising STIs and integrate gonorrhoea surveillance into national STI programmes.”

Without rapid investment and coordinated global action, WHO warns that drug-resistant gonorrhoea could become a major international health crisis, threatening sexual health services, reproductive outcomes, and public health systems worldwide.