More countries are reporting rising levels of drug-resistant gonorrhea, WHO warns

The World Health Organization (WHO) warns that gonorrhea, a sexually transmitted infection, is becoming increasingly resistant to antibiotics, according to new data from Enhanced Gonococcal Antimicrobial Surveillance Program (EGASP)which monitors the spread of drug-resistant gonorrhea.

The report highlights the need to strengthen surveillance, improve diagnostic capacities and ensure equal access to new treatments for sexually transmitted infections (STIs). The publication of new data coincides with World Antimicrobial Resistance (AMR) Awareness Week.thus underscoring the importance of global action against drug-resistant infections. EGASP, launched by WHO in 2015, collects laboratory and clinical data from control sites around the world to monitor AMR and inform treatment guidelines.

“This global effort is critical to monitoring, preventing and responding to drug-resistant gonorrhea and protecting public health worldwide,” said Dr Tereza Kasaeva, Director of the WHO Division of HIV, TB, Hepatitis and STIs. “WHO urges all countries to address rising levels of sexually transmitted infections (STIs) and integrate gonorrhea surveillance into national STI programs.”

Between 2022 and 2024, resistance to ceftriaxone and cefixime, the primary antibiotics used to treat gonorrhea, increased sharply from 0.8% to 5% and from 1.7% to 11%, respectively, with resistant strains detected in more countries. Resistance to azithromycin remained stable at 4%, while resistance to ciprofloxacin reached 95%. Cambodia and Vietnam reported the highest rates of resistance.

In 2024, 12 EGASP countries in five WHO regions submitted data, an increase from just four countries in 2022. This is a positive development that reflects the increasing commitment to monitor and control drug-resistant infections in countries and regions. Countries – Brazil, Cambodia, India, Indonesia, Malawi, Philippines, Qatar, South Africa, Sweden, Thailand, Uganda and Vietnam reported 3,615 cases of gonorrhea.

More than half of all cases of symptomatic gonorrhea in men (52%) were reported from countries in the WHO Western Pacific Region, including the Philippines (28%), Vietnam (12%), Cambodia (9%) and Indonesia (3%). Countries in the African region of the World Health Organization recorded 28% of cases, followed by countries in the Southeast Asian region (13%, Thailand), the Eastern Mediterranean region (4%, Qatar) and the Americas region (2%, Brazil).

The average age of the patients was 27 years (range: 12–94). Among the cases, 20% were men who had sex with men, and 42% reported multiple sexual partners in the past 30 days. Eight percent reported recent antibiotic use, and 19% had recent travel.

Strengthening and expanding global surveillance

In 2024, WHO advanced genomic surveillance, with nearly 3,000 samples sequenced from eight countries. Significant studies on new treatments such as zoliflodazine and gepotidacin, as well as studies on tetracycline resistance, were carried out by the WHO Collaborating Center for AMR in STI, Sweden, in coordination with WHO. They help guide future gonorrhea control strategies and doxycycline-based prevention (DoxyPEP).

EGASP continued to expand its reach in 2024, with Brazil, Côte d'Ivoire, and Qatar joining the program, and India beginning implementation and data reporting beginning in 2025 under its National AIDS and STD Control Program.

Despite significant progress, EGASP faces challenges, including limited funding, incomplete reporting, and gaps in data on women and extragenital sites. WHO calls for urgent investment, particularly in national surveillance systems, to maintain and expand global surveillance of gonococcal AMR.