Global Gonorrhoea Resistance Escalates, Demanding Urgent Action, WHO Reports
Teh World Health Association (WHO) has issued a warning about the increasing prevalence of drug-resistant gonorrhoea, highlighting a critical need for strengthened surveillance, improved diagnostics, and equitable access to treatment. The report’s release coincides with World Antimicrobial Resistance (AMR) Awareness Week, underscoring the interconnectedness of combating drug resistance across all infections.
Data collected through the WHO’s Gonococcal Antimicrobial Surveillance Programme (EGASP), launched in 2015, reveals a concerning trend. Between 2022 and 2024, resistance to ceftriaxone – a primary antibiotic for gonorrhoea treatment – rose considerably from 0.8% to 5%. Simultaneously, resistance to cefixime, another key antibiotic, jumped from 1.7% to 11%, with resistant strains now identified in a greater number of countries. While azithromycin resistance remained stable at 4%,resistance to ciprofloxacin is alarmingly high,reaching 95%. Cambodia and viet Nam are currently reporting the highest rates of resistance.
In 2024, twelve countries across five WHO regions – Brazil, Cambodia, India, Indonesia, Malawi, the Philippines, Qatar, South africa, Sweden, Thailand, Uganda, and Viet Nam – contributed data to EGASP, a considerable increase from the four countries participating in 2022. These countries reported a total of 3,615 cases of gonorrhoea.
Geographically, over half (52%) of symptomatic gonorrhoea cases in men were reported from the WHO Western Pacific Region, with the Philippines accounting for 28%, Viet Nam for 12%, Cambodia for 9%, and Indonesia for 3%. The WHO African Region contributed 28% of cases, followed by the South-East asia Region (13%, primarily Thailand), the Eastern Mediterranean Region (4%, Qatar), and the Region of the Americas (2%, Brazil).
Analysis of reported cases reveals a median patient age of 27 years (ranging from 12 to 94). A significant proportion of cases involved men who have sex with men (20%), and a substantial 42% of individuals reported having multiple sexual partners in the preceding 30 days.Recent antibiotic use was reported by 8% of patients, and 19% had recently travelled.
The WHO is actively advancing genomic surveillance, having sequenced nearly 3,000 samples from eight countries in 2024.research conducted through the WHO’s Collaborating Center on AMR in STI in Sweden is evaluating new treatments, including zoliflodacin and gepotidacin, and investigating tetracycline resistance, to inform future control strategies and the implementation of doxycycline-based prevention (DoxyPEP).
EGASP is expanding, with Brazil, Côte d’Ivoire, and Qatar recently joining the program, and India set to begin data reporting in 2025. However,the program faces challenges including limited funding,incomplete data reporting,and insufficient data from women and extragenital sites.
dr. Tereza Kasaeva, Director of the WHO Department for HIV, TB, Hepatitis & STIs, emphasized the importance of this global effort, stating, “This global effort is essential to tracking, preventing, and responding to drug-resistant gonorrhoea and to protecting public health worldwide.” The WHO is urging all countries to address rising STI levels and integrate gonorrhoea surveillance into their national STI programs, calling for urgent investment in national surveillance systems to sustain and expand global monitoring of gonococcal AMR.
