The World Health Organisation has sounded a global alarm over the rapid spread of highly drug-resistant gonorrhoea, warning that this common sexually transmitted infection is becoming increasingly difficult to treat effectively.
Antibiotic Resistance Reaches Critical Levels
New data from WHO's Enhanced Gonococcal Antimicrobial Surveillance Programme reveals widespread resistance to multiple antibiotics, with the most shocking finding being a 95% global resistance rate to ciprofloxacin. The organization released these alarming statistics during World Antimicrobial Resistance Awareness Week to highlight the growing threat of drug-resistant infections.
Between 2022 and 2024, resistance to ceftriaxone and cefixime - the primary antibiotics used for gonorrhoea treatment - showed dramatic increases. Ceftriaxone resistance jumped from 0.8% to 5%, while cefixime resistance surged from 1.7% to 11% during this two-year period. Resistance to azithromycin remained stable at 4%.
Global Surveillance and Regional Impact
The WHO surveillance program, launched in 2015, collects clinical and laboratory data from sentinel sites worldwide to track antimicrobial resistance trends. Participation has significantly expanded, with 12 countries across five WHO regions submitting data in 2024, compared to just four countries in 2022.
Regional distribution data reveals that over half of all symptomatic gonorrhoea cases in men (52%) were reported from countries in the WHO Western Pacific Region, while countries in the WHO African Region accounted for 28% of cases.
Patient demographics show a median age of 27 years, with cases ranging from 12 to 94 years old. The data further indicates that 20% of infections occurred among men who have sex with men, and 42% of patients reported having multiple sexual partners within the preceding 30 days.
Factors Contributing to Resistance Spread
Several factors were identified as contributing to the spread of resistant strains. The surveillance data showed that 8% of patients had used antibiotics recently, while 19% had travelled shortly before diagnosis - both behaviors that can accelerate the spread of drug-resistant infections.
Dr Tereza Kasaeva, Director of the WHO Department for HIV, TB, Hepatitis & STIs, emphasized that the surveillance programme is essential for protecting global health. She stated that the growing resistance patterns underscore the urgency of strengthening STI surveillance systems worldwide.
Kasaeva urged countries to prioritize monitoring and integrate gonorrhoea surveillance into national STI programmes to curb the spread of resistant strains.
Advances in Research and Ongoing Challenges
On a positive note, WHO reported significant advances in genomic surveillance, with nearly 3,000 samples sequenced across eight countries in 2024 to better understand resistance evolution. Landmark studies on new treatment options such as zoliflodacin and gepotidacin were conducted through WHO's Collaborating Centre on AMR in STIs in Sweden.
These studies will inform future control strategies, including the development of doxycycline-based preventive approaches. However, WHO acknowledged that significant challenges persist, including limited funding, incomplete reporting, and data gaps, particularly for women and extragenital infection sites.
The organization called for increased investment in national surveillance systems to sustain and strengthen global efforts to monitor and combat gonococcal antimicrobial resistance before the situation becomes untreatable.
