Antibiotic-Resistant Gonorrhoea Cases Rise in England

Health experts have warned of a rise in antibiotic-resistant gonorrhoea cases in England, including extensively drug-resistant (XDR) strains.

New data from the UK Health Security Agency (UKHSA) showed that since the first detection of ceftriaxone-resistant gonorrhoea in 2015, 42 cases have been reported. Of these, 15 were XDR cases, resistant to both ceftriaxone and second-line treatment options. 

Thought overall numbers remain low, cases are being detected “more frequently”, the UKHSA said. From January 2024 to March 2025, 17 cases were recorded, surpassing the 16 cases reported in the 2-year period between January 2022 and December 2023. 

XDR cases nearly doubled in the same period, rising from five to nine.

“Gonorrhoea is becoming increasingly resistant to antibiotics, which could make it untreatable in future,” warned Katy Sinka, a consultant epidemiologist and head of sexually transmitted infections at the UKHSA.

Resistance to Every Class of Antibiotic

Gonorrhoea diagnoses have been rising since the early 2000s, with a temporary decline in 2020 and 2021, largely due to a decline in testing during disruption to sexual health services during the COVID-19 pandemic.

Provisional data showed approximately 54,965 gonorrhoea diagnoses at sexual health services in the first 9 months of 2024, compared with 85,223 recorded in the whole of 2023 – the highest reported number since 1918.

Neisseria gonorrhoeae has developed resistance to every class of antibiotic used for treatment. Cephalosporins remain the last viable class of antibiotics available for use as empirical monotherapy. 

Most antibiotic-resistant gonorrhoea cases are linked to travel to or from the Asia-Pacific region, where ceftriaxone-resistance is common, highlighted the UKHSA. While domestic transmission in England has been limited, rising case numbers increase the chance of wider spread and treatment challenges.

Neisseria Gonorrhoeae on High-Risk Pathogen Watchlist

Earlier this week the UKHSA warned of the re-emergence and re-establishment of a number of infectious diseases since 2022. Neisseria gonorrhoeae has also been included in the UKHSA’s watchlist of high-threat pathogens that may pose the greatest risk to public health. 

In November 2023, the Joint Committee on Vaccination and Immunisation (JCVI) recommended targeted use of the MenB vaccine to protect individuals most at risk of contracting gonorrhoea. The JCVI found that the vaccine – primarily used to tackle Meningitis B in children – was approximately 40% effective at preventing people from contracting and spreading gonorrhoea. The committee decided that a rollout of the vaccine would be cost-effective if given to at risk individuals, including gay and bisexual men and those with a history of STIs. 

“If we don’t deal with it now, we’re going to see more people with serious types of gonorrhoea and more cases of antibiotic resistance,” said Professor Matt Phillips, president of the British Association for Sexual Health and HIV (BASHH), in an interview with the BBC.

Dr Rob Hicks is a retired NHS doctor. A well-known TV and radio broadcaster, he has written three books and has regularly contributed to national newspapers, magazines, and online. He is based in the UK.