The World Health Organization (WHO) has raised alarm over the growing global threat of drug-resistant gonorrhoea, a sexually transmitted infection, based on new findings from its Enhanced Gonococcal Antimicrobial Surveillance Programme (EGASP). The programme, launched in 2015, collects laboratory and clinical data from sentinel sites worldwide to monitor antimicrobial resistance (AMR) and guide treatment strategies. WHO emphasizes the urgent need to strengthen surveillance, expand diagnostic capacity, and ensure equitable access to new treatments for sexually transmitted infections (STIs), particularly as drug-resistant strains become more widespread.
Between 2022 and 2024, resistance to the key antibiotics ceftriaxone and cefixime increased sharply from 0.8% to 5% and 1.7% to 11% respectively, with resistant strains detected in more countries. Resistance to azithromycin remained stable at 4%, while resistance to ciprofloxacin reached 95%, with Cambodia and Viet Nam reporting the highest rates. The report also noted a positive trend: in 2024, 12 countries across five WHO regions provided EGASP data, up from just four in 2022, reflecting a growing commitment to monitor and contain drug-resistant infections. These countries reported 3,615 cases of gonorrhoea, with over half of symptomatic cases in men occurring in the WHO Western Pacific Region, including the Philippines, Viet Nam, Cambodia, and Indonesia.
The median age of patients was 27 years, and cases included 20% men who have sex with men, 42% reporting multiple sexual partners, 8% with recent antibiotic use, and 19% with recent travel. WHO has expanded genomic surveillance, sequencing nearly 3,000 samples from eight countries, while conducting studies on new treatments such as zoliflodacin and gepotidacin and on tetracycline resistance. These efforts aim to guide future gonorrhoea control strategies and doxycycline-based prevention.
EGASP continues to grow, with Brazil, Côte d’Ivoire, and Qatar joining in 2024, and India starting implementation and reporting in 2025. Despite progress, challenges remain, including limited funding, incomplete reporting, and insufficient data from women and extragenital sites. WHO calls for urgent investment in national surveillance systems to sustain and expand global monitoring of gonococcal AMR and protect public health worldwide.
