There progress of ‘super gonorrhea’. “More and more countries are reporting an upward trend.” And these sexually transmitted infections are “becoming increasingly resistant to antibiotics.” This is a warning launched by the World Health Organization (WHO) based on new data from the EGASP surveillance program, which monitors the spread of drug-resistant gonorrhea. The report highlights the need to “strengthen surveillance, increase diagnostic capacity and ensure equitable access to new treatments for sexually transmitted infections (STIs)”. The release of the new data coincides with World Antimicrobial Resistance (AMR) Awareness Week, and reinforces the message about the importance of “global action against drug-resistant infections”.
EGASP, launched by WHO in 2015, collects laboratory and clinical data from sentinel sites around the world to monitor antibiotic resistance and provide treatment guidelines. “This global effort is important to monitor, prevent and respond to drug-resistant gonorrhea and to protect public health worldwide,” said Tereza Kasaeva, director of WHO’s Department of HIV, TB, Hepatitis & sexually transmitted infections. “WHO calls on all countries to address rising rates of sexually transmitted infections and integrate gonorrhea surveillance into national programs for this disease.”
Antibiotic resistance
Between 2022 and 2024, resistance to ceftriaxone and cefixime, the main antibiotics used to treat gonorrhea, increased dramatically, from 0.8% to 5% and from 1.7% to 11%, respectively, with resistant strains detected in more countries. Azithromycin resistance remained stable at 4%, while ciprofloxacin resistance reached 95%. Cambodia and Vietnam have the highest resistance rates. The positive side is that 12 countries in the EGASP surveillance network across 5 WHO regions are providing data in 2024, up from just 4 countries in 2022. These countries (Brazil, Cambodia, India, India, Malawi, the Philippines, Qatar, South Africa, Sweden, Thailand, Uganda and Vietnam) reported 3,615 cases of gonorrhea. More than half of symptomatic gonorrhea cases in men (52%) were reported in countries in the WHO Western Pacific region, including the Philippines (28%), Vietnam (12%), Cambodia (9%) and Indonesia (3%). Countries in the African region accounted for 28% of cases, followed by countries in the Southeast Asia region (13%, Thailand), the Eastern Mediterranean region (4%, Qatar), and America (2%, Brazil).
The mean age of patients was 27 years (range, 12 to 94 years). Among the cases, 20% were men who have sex with men, and 42% reported having multiple sexual partners in the past 30 days. Eight percent reported recent antibiotic use and 19% reported recent travel.
In 2024, WHO increased genome surveillance, with nearly 3,000 samples sequenced from 8 countries. Studies on new treatments such as zoliflodacin and gepotidacin, as well as studies on tetracycline resistance, are carried out by the WHO Collaborating Center on Antimicrobial Resistance in Sweden, in coordination with the UN agency. These studies help guide future gonorrhea control and doxycycline-based prevention strategies. EGASP continues to expand its reach in 2024, with Brazil, Ivory Coast and Qatar joining, and India begins implementation and reporting in 2025 under the National Program for the Control of AIDS and Sexually Transmitted Diseases.
Despite progress, WHO concluded, surveillance programs “face challenges such as limited funding, incomplete reporting, and data gaps regarding women and sites of infection outside the genitals.” WHO called for “urgent investment, particularly in national surveillance systems, to support and expand global surveillance of gonococcal antimicrobial resistance.”
