Drug-Resistant Gonorrhoea on the Rise in Europe as Domestic Transmission Emerges, ECDC Warns
核心洞察
ECDC reports a surge in ceftriaxone-resistant Neisseria gonorrhoeae (搜索) across Europe since 2022, with 2024 marking the highest notification level since EU surveillance began in 2009 at over 106,000 confirmed cases.
While early cases were travel-associated, 2025–2026 data show growing evidence of domestic transmission within the EU/EEA and UK, with notable increases in France, Germany, Sweden, and the UK.
The overall risk for the general sexually active population remains low, but is moderate for travelers to high-prevalence areas such as South-East Asia who engage in higher-risk sexual behaviors.
European health authorities are sounding the alarm over a sharp rise in gonorrhoea (搜索) infections resistant to ceftriaxone, the last remaining first-line antibiotic for this common sexually transmitted infection. In a risk assessment published by the European Centre for Disease Prevention and Control (搜索) (ECDC), officials detail an evolving epidemiological picture in which cases once largely tied to international travel are now spreading domestically across multiple European nations.
The assessment draws on reports from 11 European countries and highlights that since 2022, an increasing number of EU/EEA member states have detected ceftriaxone-resistant Neisseria gonorrhoeae (搜索), including multidrug-resistant (MDR) and extensively drug-resistant (XDR) strains. France, Germany, Sweden, and the United Kingdom have reported notable increases, while several other countries continue to detect sporadic cases.
Shifting Transmission Patterns
Early detections of ceftriaxone-resistant gonorrhoea (搜索) in Europe were predominantly sporadic and associated with importation from regions with higher circulation of resistant strains, particularly South-East Asia. That pattern is now changing. According to the ECDC, clusters and locally acquired infections documented through 2025–2026 indicate that onward transmission is now occurring within Europe.
"Importation from areas with higher circulation of resistant strains, particularly in South-East Asia, remains an important route of introduction, but clusters and locally acquired infections indicate that onward transmission is now occurring within Europe," the ECDC states in its assessment.
Disease Burden and Clinical Consequences
Gonorrhoea (搜索) remains one of the most common bacterial sexually transmitted infections globally, with an estimated 82 million reported infections each year. In the EU/EEA, more than 106,000 confirmed cases were recorded in 2024—the highest notification level since European surveillance began in 2009. If left untreated, gonorrhoea can lead to severe complications including pelvic inflammatory disease, infertility, and ectopic pregnancy.
Risk Stratification
The ECDC's risk assessment stratifies the threat across different population groups. For the general sexually active population in the EU/EEA who do not engage in behaviors associated with an increased probability of acquiring STIs, the overall risk is assessed as low.
The risk rises to low-to-moderate for people with multiple or frequently changing sexual partners and those having condomless sex with casual or new partners. For individuals living in the EU/EEA who travel to areas with increased circulation of ceftriaxone-resistant MDR/XDR N. gonorrhoeae and engage in higher-risk sexual behaviors, the overall risk is assessed as moderate.
Threat to First-Line Treatment
The most concerning implication of the evolving resistance patterns is the potential erosion of current treatment options. The ECDC warns that if sustained transmission of ceftriaxone-resistant MDR/XDR N. gonorrhoeae becomes established in the EU/EEA, the effectiveness of currently recommended first-line treatment regimens—ceftriaxone monotherapy or in combination with azithromycin—could be substantially reduced, potentially limiting treatment options and complicating case management.
Although reported cases remain limited and all documented infections to date have been successfully treated, the increasing detections, evidence of domestic transmission, and narrowing treatment options indicate a risk of further escalation if control measures are not implemented and maintained.
Prevention and Public Health Response
Prevention of gonorrhoea (搜索) infection remains straightforward, the ECDC emphasizes, through correct and consistent use of condoms or other barrier methods during sex, regular testing especially after sex with new, casual, or multiple sexual partners, and seeking testing after possible exposure.
The agency has issued several recommendations for public health authorities and healthcare providers to address the risk and maintain the effectiveness of current gonorrhoea (搜索) treatments, underscoring the urgency of coordinated surveillance and antimicrobial stewardship across the region.