Last-line resistant gonorrhoea is now showing domestic transmission in Europe

ECDC has found evidence that ceftriaxone-resistant multidrug- and extensively drug-resistant gonorrhoea is spreading within the EU/EEA and UK. General risk remains low, but narrowing treatment options require stronger surveillance and test-of-cure.

Verification date and core finding

As of 21 July 2026, ECDC’s 16 July risk assessment reports increasing detection of ceftriaxone-resistant gonorrhoea and growing evidence of domestic transmission within the EU/EEA and the United Kingdom. France, Germany, Sweden and the UK reported notable increases. Earlier cases were often isolated and travel-associated; clusters and locally acquired infections now show onward transmission in Europe.

What makes this remarkable

Ceftriaxone is central to recommended first-line treatment, so resistance matters even while case numbers remain limited. The strains include multidrug-resistant and extensively drug-resistant forms. ECDC says all reported infections have so far been treated successfully, but sustained transmission could reduce the effectiveness of current regimens and complicate case management.

What changed

The 2024 Euro-GASP surveillance data provide the background. Twenty-four countries participated; 4,516 isolates were submitted and 3,371 were included in the analysed dataset. Two ceftriaxone-resistant isolates were identified in that dataset, compared with one in 2023, and every ceftriaxone-resistant isolate detected there was classified as extensively drug-resistant.

Why it matters now

Other resistance is already widespread. Azithromycin values above the epidemiological cutoff were found in 19.1% of analysed isolates and in 23 of 24 participating countries. Roughly two-thirds remained resistant to ciprofloxacin. This does not mean every infection is untreatable, but it shows why laboratories need culture, susceptibility testing and genomic surveillance.

What it means for the world and readers

ECDC assesses risk as low for the general sexually active EU/EEA population without higher-risk behaviour, low-to-moderate for people with multiple or frequently changing partners or condomless sex with new or casual partners, and moderate for exposed travellers to higher-circulation areas. Testing after symptoms or possible exposure, correct treatment and partner notification reduce onward transmission.

Limits that must not be overstated

This is not evidence of an uncontrollable European epidemic, and the assessment should not stigmatize any nationality, orientation or community. Gonorrhoea can be asymptomatic, and only laboratory testing can identify infection and resistance. Antibiotics should not be self-selected, shared or stopped early; suspected treatment failure requires clinical follow-up and, where feasible, a test of cure.

What to check in official sources

The ECDC risk assessment provides affected areas, risk levels and recommendations for clinicians and the public. The Euro-GASP report supplies tested-isolate counts and resistance proportions. The disease surveillance portal is the place to check later reports. National health authorities remain the correct source for local testing and treatment pathways.

ECDC risk assessment on ceftriaxone-resistant gonorrhoea

ECDC Euro-GASP antimicrobial susceptibility surveillance

ECDC gonorrhoea surveillance portal

Next checkpoint and today’s takeaway

The next checkpoint is updated case reporting and genomic evidence showing whether domestic clusters expand or are contained. For readers, the immediate conclusion is measured: general risk remains low, but people with symptoms, exposure or relevant travel should test promptly and follow prescribed treatment, because resistance is narrowing the margin for delayed or incorrect care.