The rise in antibiotic-resistant gonorrhoea cases in England has become a growing concern among health experts. New data from the UK Health Security Agency (UKHSA) has revealed a troubling trend, with cases of gonorrhoea becoming increasingly resistant to treatment, including cases of extensively drug-resistant (XDR) strains. Since the first detection of ceftriaxone-resistant gonorrhoea in 2015, 42 cases have been reported, including 15 cases of XDR gonorrhoea that are resistant to both ceftriaxone and second-line treatments.

Rising Cases and Resistance

Gonorrhoea, caused by the bacterium Neisseria gonorrhoeae, has been a major public health issue due to its ability to evolve and become resistant to antibiotics. The UKHSA’s latest findings indicate a significant rise in the number of antibiotic-resistant cases, particularly XDR gonorrhoea. Although the overall number of cases remains relatively low, the frequency with which these cases are being detected has increased sharply. For instance, from January 2024 to March 2025, 17 cases of ceftriaxone-resistant gonorrhoea were reported, which surpasses the 16 cases recorded over the previous two years (from January 2022 to December 2023). This increase is alarming, especially since the number of XDR gonorrhoea cases nearly doubled in the same period, rising from five to nine.

Related News

Health experts are particularly concerned because gonorrhoea is becoming resistant to every class of antibiotics used for its treatment, posing a serious risk of the disease becoming untreatable in the future. Katy Sinka, a consultant epidemiologist and head of sexually transmitted infections at the UKHSA, emphasized that without immediate action, gonorrhoea could eventually become a public health crisis.

The Threat of Untreatable Gonorrhoea

The development of antibiotic resistance in gonorrhoea has been accelerating since the early 2000s. There was a temporary decline in diagnoses in 2020 and 2021, largely due to the disruption caused by the COVID-19 pandemic and the reduced availability of sexual health services. However, provisional data from 2024 shows that gonorrhoea diagnoses have once again surged, with approximately 54,965 cases reported in the first nine months of 2024 alone. This figure is a sharp increase from the 85,223 cases reported in all of 2023, the highest number seen since 1918. This trend shows no signs of slowing down, as gonorrhoea continues to spread across the population, increasing the risk of antibiotic-resistant strains.

One of the main reasons behind the rapid rise in antibiotic-resistant gonorrhoea is the bacterium Neisseria gonorrhoeae’s ability to develop resistance to every class of antibiotics that have been used to treat the disease. Currently, cephalosporins, particularly ceftriaxone, remain the last line of defense against gonorrhoea. However, Neisseria gonorrhoeae has already developed resistance to several other classes of antibiotics, including penicillin and tetracyclines, making treatment more difficult.

In addition to growing concerns about domestic transmission in England, many antibiotic-resistant gonorrhoea cases have been linked to travel to or from regions such as the Asia-Pacific, where ceftriaxone-resistant strains of gonorrhoea are more common. Although domestic transmission within England has been relatively limited, the increasing number of cases heightens the chances of wider spread, making treatment more challenging. Health authorities are particularly worried that continued spread could eventually lead to gonorrhoea becoming a truly untreatable infection.

Impact of Gonorrhoea Resistance on Public Health

The emergence of antibiotic-resistant gonorrhoea has placed the disease on the UK Health Security Agency’s high-risk pathogen watchlist, alongside other infectious diseases that pose a significant threat to public health. Health experts have warned that unless immediate action is taken, the rise of antibiotic-resistant gonorrhoea could lead to a situation where gonorrhoea becomes virtually untreatable, putting more people at risk of severe complications, including infertility and chronic pelvic pain.

“Gonorrhoea is becoming increasingly resistant to antibiotics, which could make it untreatable in the future,” said Katy Sinka, emphasizing the urgency of addressing this issue. The rise of XDR gonorrhoea strains that are resistant to multiple antibiotics could lead to an increase in the number of people experiencing complications from the infection. These complications can include pelvic inflammatory disease (PID), infertility, and an increased risk of acquiring or transmitting HIV.

In light of the growing threat posed by antibiotic-resistant gonorrhoea, health authorities have been exploring new strategies to prevent the disease. In November 2023, the Joint Committee on Vaccination and Immunisation (JCVI) recommended the targeted use of the MenB vaccine as a preventative measure for individuals most at risk of contracting gonorrhoea. The MenB vaccine, which is primarily used to protect against Meningitis B in children, has been found to be approximately 40% effective at preventing gonorrhoea infections. The JCVI recommended rolling out the vaccine to high-risk groups, including gay and bisexual men and individuals with a history of sexually transmitted infections.

Professor Matt Phillips, president of the British Association for Sexual Health and HIV, warned that if the current trend of rising gonorrhoea cases and antibiotic resistance continues, it could result in more people being affected by serious forms of the disease. He emphasized the need for immediate action to prevent further spread, stating, “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.”

The MenB vaccine could play an important role in reducing the number of gonorrhoea cases, particularly in high-risk groups. However, experts agree that more research is needed to determine the vaccine’s effectiveness in preventing the disease and to develop other vaccines or treatments to combat antibiotic-resistant strains.

Challenges in Tackling Gonorrhoea Resistance

Tackling antibiotic-resistant gonorrhoea presents a complex challenge for healthcare professionals and policymakers. One of the main hurdles is the lack of a comprehensive and coordinated global approach to addressing the rise of resistance in gonorrhoea. As the UKHSA pointed out, many cases of antibiotic-resistant gonorrhoea are linked to travel, making international collaboration essential to controlling the spread of resistant strains. Furthermore, the continued overuse and misuse of antibiotics in both human medicine and animal agriculture have contributed to the acceleration of resistance.

In addition, gonorrhoea’s ability to quickly develop resistance to antibiotics makes it difficult to develop new treatments in a timely manner. The rapid mutation of Neisseria gonorrhoeae means that new strains of the bacterium can quickly emerge, often rendering existing treatments ineffective. This highlights the need for ongoing research into new antibiotics, as well as the development of novel strategies to combat resistance.

 The Need for Urgent Action

The rise of antibiotic-resistant gonorrhoea in England represents a significant public health threat that could have serious consequences for individuals and communities. With gonorrhoea increasingly resistant to available antibiotics, the disease could eventually become untreatable, leading to widespread health complications. While the number of cases remains relatively low, the frequency of detection is rising, and the emergence of XDR gonorrhoea strains is particularly concerning.

In order to prevent a future public health crisis, urgent action is required. This includes strengthening global efforts to combat antibiotic resistance, promoting responsible antibiotic use, and continuing to invest in the development of new treatments and vaccines. The implementation of targeted vaccination programs, such as the MenB vaccine, may help reduce the spread of gonorrhoea, particularly in high-risk populations.

If we do not act quickly and decisively, gonorrhoea could soon become a disease that is no longer treatable, leaving many individuals vulnerable to its serious and often devastating complications. Addressing this growing threat now is essential to safeguarding public health in the future.