WHO Warns of Rising Global Drug-Resistant Gonorrhoea Cases

The World Health Organization (WHO) has sounded a global alarm as new data from its Enhanced Gonococcal Antimicrobial Surveillance Programme (EGASP) shows a sharp rise in antibiotic-resistant gonorrhoea worldwide. The findings were released during World Antimicrobial Resistance (AMR) Awareness Week, underscoring the urgent need for stronger prevention, diagnosis, and treatment strategies for sexually transmitted infections (STIs).

Sharp Increase in Key Antibiotic Resistance
Between 2022 and 2024, resistance to two primary antibiotics—ceftriaxone and cefixime—rose significantly:

• Ceftriaxone resistance: 0.8% → 5%

• Cefixime resistance: 1.7% → 11%

Resistance to ciprofloxacin reached an alarming 95%, while azithromycin resistance remained steady at 4%. Cambodia and Viet Nam reported the highest levels of resistant strains.

Cases and Regions Most Affected
In 2024, twelve countries across five WHO regions submitted data, up from just four in 2022—reflecting greater global participation in surveillance efforts. These countries—Brazil, Cambodia, India, Indonesia, Malawi, the Philippines, Qatar, South Africa, Sweden, Thailand, Uganda and Viet Nam—reported 3,615 gonorrhoea cases.
Key trends:

• 52% of symptomatic male cases came from the Western Pacific Region, led by the Philippines, Viet Nam, Cambodia and Indonesia.

• The African Region contributed 28% of cases.

• South-East Asia reported 13%, primarily from Thailand.

• The Eastern Mediterranean Region and the Americas accounted for 4% and 2% respectively.

The median patient age was 27 years, with notable behavioural patterns:

• 20% were men who have sex with men.

• 42% reported multiple sexual partners in the past month.

• 8% had recently used antibiotics.

• 19% had travelled recently.

Advances and Gaps in Surveillance
WHO expanded genomic surveillance in 2024, sequencing nearly 3,000 samples from eight countries. Research on new drug candidates—zoliflodacin and gepotidacin—and studies on tetracycline resistance are informing future treatment and prevention strategies, including the DoxyPEP approach.

The EGASP network also grew, with Brazil, Côte d’Ivoire and Qatar joining the programme, while India is set to begin official reporting in 2025.

Despite progress, major challenges remain:

• Limited funding

• Incomplete data

• Insufficient reporting from women and extragenital sites

Urgent Call for Action
Dr Tereza Kasaeva, Director of WHO’s Department for HIV, TB, Hepatitis & STIs, emphasized that robust surveillance is essential to protect global health. WHO is urging countries to integrate gonorrhoea monitoring into national STI programmes and invest in stronger surveillance systems to combat rapidly growing antimicrobial resistance.