ECDC assesses upsurge in ceftriaxone-resistant gonorrhoea with domestic transmission in EU/EEA and UK

The European Centre for Disease Prevention and Control (ECDC) published a risk assessment on 16 July 2026 warning of an upsurge in gonorrhoea cases caused by ceftriaxone-resistant Neisseria gonorrhoeae, including multidrug-resistant (MDR) and extensively drug-resistant (XDR) strains, across the EU/EEA and the UK. Since 2022, an increasing number of European countries have reported such cases, with the situation evolving in 2025–2026 to include rising numbers and growing evidence of domestic transmission, according to the assessment (ECDC).

Early detections were mainly sporadic and often linked to travel, particularly from South-East Asia, which remains a primary route of introduction. However, clusters and locally acquired infections now indicate onward transmission within Europe. France, Germany, Sweden and the UK have reported notable increases, while other countries continue to detect sporadic cases, the ECDC stated in its accompanying news release (ECDC).

Reports informing the assessment came from 11 countries: Austria, Croatia, Denmark, France, Germany, Ireland, the Netherlands, Norway, Spain, Sweden and the United Kingdom. In the UK, cases rose from 13 in 2024 to 29 in 2025, with 17 already recorded by June 2026, including a cluster of six in a sexual network without recent international travel. Sweden reported nine cases in 2025 plus four in the first half of 2026, several acquired domestically. France identified at least 17 MDR or XDR cases since January 2025 across clusters, some domestic. Germany reported seven in 2025. Other nations logged smaller numbers, some without travel history (StudyFinds summary of ECDC data; The Sun).

Gonorrhoea remains one of the most common bacterial sexually transmitted infections globally, with an estimated 82 million infections yearly. In the EU/EEA, more than 106,000 confirmed cases were reported in 2024—the highest since EU surveillance began in 2009. Untreated infection can cause pelvic inflammatory disease, infertility, ectopic pregnancy and other complications (ECDC).

Ceftriaxone is the principal first-line treatment in Europe, often used alone or with azithromycin. N. gonorrhoeae has developed resistance to multiple prior drug classes. Six treatment failures, all extra-genital (mostly pharyngeal), were reported, primarily in the UK; four resolved with additional ceftriaxone plus azithromycin and two required intravenous ertapenem. All reported infections were ultimately successfully treated, though options are narrowing for MDR/XDR strains (StudyFinds).

ECDC assesses the overall risk as low for the general sexually active population in the EU/EEA not engaging in higher-risk behaviours. It is low-to-moderate for those with multiple or frequently changing partners or condomless sex with casual/new partners, and moderate for travellers to high-prevalence areas who engage in higher-risk behaviours. If sustained transmission of resistant strains becomes established, current first-line regimens could lose effectiveness (ECDC risk assessment).

Csaba Ködmön, an ECDC microbiology expert, stated: “Local transmission of ceftriaxone-resistant gonorrhoea in Europe is a warning sign we should not ignore. While the risk to the general population is currently low, growing resistance reduces the effectiveness of the therapies we rely on today.” Recommendations include strengthened culture-based antimicrobial resistance surveillance and genomic monitoring; appropriate multi-site testing and guideline-aligned treatment with test-of-cure where indicated; reinforced partner notification; and clear public messaging on condom use, regular testing after new or casual partners, and prompt care after symptoms or exposure (ECDC; Labmate Online).

Prevention centres on consistent barrier methods and regular STI testing. Alternative agents such as zoliflodacin and gepotidacin have shown promise in late-stage trials, and countries are advised to prepare access pathways.