Drug-Resistant Gonorrhoea Spreading Across Europe, ECDC Warns

The European Centre for Disease Prevention and Control warns that drug-resistant gonorrhea is spreading domestically within Europe. While historically imported from South-East Asia, ceftriaxone-resistant strains are now transmitting person-to-person, particularly in Sweden, France, Germany, and the United Kingdom. The UK has recorded six treatment failures, some requiring intravenous ertapenem. Although the overall risk remains low, officials urge stronger surveillance and testing.

Domestic ceftriaxone-resistant transmission

• ▪European health authorities reported that patients with no travel history are testing positive for ceftriaxone-resistant gonorrhea, indicating person-to-person domestic transmission.
• ▪The European Centre for Disease Prevention and Control warned of an upsurge in ceftriaxone-resistant Neisseria gonorrhoeae infections with evidence of domestic transmission in Europe since 2022.
• ▪Early detections of ceftriaxone-resistant gonorrhea in Europe were primarily associated with travel-related importation from South-East Asia.

Treatment failures requiring alternatives

• ▪The European Centre for Disease Prevention and Control advises countries to arrange access to replacement drugs zoliflodacin and gepotidacin, which have cleared late-stage trials.
• ▪Out of six treatment failures in the United Kingdom, four cleared with a second round of ceftriaxone and azithromycin, while two required intravenous ertapenem.
• ▪The United Kingdom recorded six treatment failures of ceftriaxone-resistant gonorrhea, all involving extra-genital infections such as pharyngeal and rectal cases.

Case clusters in four countries

• ▪France identified at least 17 multidrug-resistant or extensively drug-resistant gonorrhea infections across three separate clusters since January 2025, with five acquired domestically.
• ▪Germany reported seven ceftriaxone-resistant gonorrhea cases in 2025, with five linked to South-East Asia travel and two to domestic transmission.
• ▪The United Kingdom recorded 13 ceftriaxone-resistant gonorrhea cases in 2024, 29 in 2025, and 17 by June 2026, including a cluster of six cases in a single sexual network.
• ▪Sweden, France, Germany, and the United Kingdom have reported rising case counts and localized clusters of ceftriaxone-resistant gonorrhea.
• ▪Sweden identified 13 ceftriaxone-resistant gonorrhea infections in 2025 and 2026, with seven of those cases acquired domestically.

Heterosexual network spread patterns

• ▪The United Kingdom reported its first ceftriaxone-resistant gonorrhea cases among bisexual men and women in 2026, suggesting spread beyond previously affected networks.
• ▪While overall European gonorrhea transmission predominantly occurs among men who have sex with men, reported ceftriaxone-resistant cases are moving through predominantly heterosexual networks.
• ▪Patients in reported ceftriaxone-resistant gonorrhea cases are mostly adults aged 20 to 50, with 60% to 80% being male.

Surveillance culture testing gaps

• ▪Many gonorrhea diagnoses rely on genetic tests that do not culture the bacteria, leaving the resistance profiles of those infections uncharacterized.
• ▪Poland reported the lowest notification rates of bacterial sexually transmitted infections in the European Union, raising concerns about under-ascertainment and diagnostic gaps.
• ▪Only 24 out of 30 European Union countries participated in the regional gonorrhea antimicrobial resistance surveillance program in 2024.