ECDC warns of rising ceftriaxone-resistant gonorrhoea with domestic transmission in Europe

The European Centre for Disease Prevention and Control (ECDC) warned on 16 July 2026 that an increasing number of European countries have detected gonococcal strains resistant to ceftriaxone, the first-line antibiotic used to treat gonorrhoea. A new risk assessment highlights growing evidence of domestic transmission of these resistant strains within the EU/EEA and the United Kingdom over the past two years, posing challenges for future treatment options (ECDC).

According to the assessment, early detections of ceftriaxone-resistant Neisseria gonorrhoeae since 2022 were mainly sporadic and often linked to travel, particularly from South-East Asia. The situation evolved in 2025–2026, with rising case numbers and clusters indicating onward local transmission. Notable increases have been reported in France, Germany, Sweden and the UK, while sporadic cases continue in countries including Austria, Croatia, Denmark, Ireland, the Netherlands, Norway and Spain (ECDC risk assessment).

In France, at least 17 multidrug-resistant (MDR) or extensively drug-resistant (XDR) cases were identified since January 2025, including clusters. Sweden saw cases rise from sporadic levels (zero to three annually in prior years) to nine in 2025 and additional cases in early 2026. Importation remains a key introduction route, but domestic spread is now occurring (ECDC PDF risk assessment).

“Local transmission of ceftriaxone-resistant gonorrhoea in Europe is a warning sign we should not ignore,” said Csaba Ködmön, an ECDC microbiology expert. “While the risk to the general population is currently low, growing resistance reduces the effectiveness of the therapies we rely on today. If highly drug-resistant strains become established and continue to spread, treatment options could become increasingly limited” (ECDC).

The overall risk is assessed as low for the general sexually active population in the EU/EEA. It rises to low-to-moderate for people with multiple or frequently changing partners or those having condomless sex with casual or new partners, and moderate for those travelling to high-prevalence areas who engage in higher-risk behaviours. All reported infections to date have been successfully treated, but sustained transmission could reduce the effectiveness of current first-line regimens (ceftriaxone alone or with azithromycin) (ECDC risk assessment).

Gonorrhoea is among the most common bacterial sexually transmitted infections globally, with an estimated 82 million new cases annually among people aged 15–49. In the EU/EEA, more than 106,000 confirmed cases were reported in 2024 across 28 countries—the highest notification level since EU surveillance began in 2009. Notification rates have risen 303% since 2015, though some of the increase may reflect expanded screening and better reporting. In 2024, 62% of cases with known transmission were among men who have sex with men (Euronews; ECDC).

Untreated infection can cause severe complications including pelvic inflammatory disease, infertility and ectopic pregnancy. Prevention relies on consistent condom use, regular testing (especially after new or casual partners), and prompt care after potential exposure. ECDC recommends strengthened gonococcal antimicrobial resistance surveillance (including culture-based and genomic testing), appropriate clinical management with test-of-cure where feasible, reinforced partner notification, and clear public messaging on safer sex and testing (ECDC risk assessment).

Current European guidelines recommend ceftriaxone-based therapy. N. gonorrhoeae has developed resistance to multiple drug classes over decades, and global data show rising resistance to extended-spectrum cephalosporins. ECDC’s existing response plan provides a framework for enhanced monitoring and control measures (EurekAlert/ECDC).