New data from the World Health Organization (WHO) from the Expanded Gonococcal Antimicrobial Resistance Surveillance Program (EGASP), which monitors the spread of drug-resistant gonorrhea, reveals that gonorrhea – a sexually transmitted infection – is becoming increasingly resistant to antibiotics.
The report shows the need to strengthen surveillance, improve diagnostic capabilities and ensure equitable access to new treatments for sexually transmitted infections (STIs). The release of these new data coincides with Global Antimicrobial Resistance Awareness Week, which highlights the importance of global action against drug-resistant infections. Launched by WHO in 2015, EGASP collects laboratory and clinical data from sentinel sites around the world to monitor antimicrobial resistance and inform treatment guidelines.
“This global work is essential to monitor, prevent and respond to drug-resistant gonorrhea, and to protect public health around the world,” said Dr.re Tereza Kasaeva, Director of the WHO Department of HIV, Tuberculosis, Hepatitis and STIs. “WHO is calling on all countries to address the rise in STI cases and integrate gonorrhea surveillance into national STI control programs. »
Between 2022 and 2024, resistance to ceftriaxone and cefixime – the main antibiotics used to treat gonorrhea – jumped from 0.8% to 5% and 1.7% to 11%, respectively, as resistant strains were detected in more countries. Azithromycin resistance remained stable at 4%, while ciprofloxacin resistance reached 95%. Cambodia and Viet Nam had the highest rates of resistance.
In 2024, 12 EGASP countries across five WHO regions provided data, a significant increase from the four countries that provided data in 2022. This is a positive development and reflects a growing commitment to monitoring and controlling drug-resistant infections at national and regional levels. The countries in question – Brazil, Cambodia, India, Indonesia, Malawi, Uganda, Philippines, Qatar, Sweden, Thailand and Viet Nam – reported 3,615 cases of gonorrhea.
More than half of cases of symptomatic gonorrhea in men (52%) were reported from countries in the WHO Western Pacific Region: 28% in the Philippines, 12% in Viet Nam, 9% in Cambodia and 3% in Indonesia. Countries in the African Region accounted for 28% of cases, followed by countries in the South-East Asia Region (13% in Thailand), the Eastern Mediterranean Region (4% in Qatar) and the Region of the Americas (2% in Brazil).
The median age of patients was 27 years (range: 12-94 years). Of the recorded cases, 20% were men who have sex with men and 42% reported having multiple sexual partners in the previous 30 days; 8% reported recent antibiotic use and 19% had recent travel.
Strengthening and expanding global surveillance
In 2024, the WHO advanced genomic surveillance: nearly 3,000 samples were sequenced in eight countries. Landmark studies of new treatments such as zoliflodacin and gepotidacin, as well as studies of tetracycline resistance, have been carried out by the WHO Collaborating Center on Antimicrobial Resistance of STIs in Sweden, in cooperation with WHO. These studies help guide future gonorrhea control and doxycycline-based prevention (DoxyPEP) strategies.
The scope of EGASP continued to expand in 2024: Brazil, Ivory Coast and Qatar joined the Program, and India began implementing activities and publishing data from 2025 as part of its national program to combat AIDS and sexually transmitted diseases.
Despite notable progress, EGASP faces challenges including limited funding, incomplete reporting, and data gaps regarding women and extra-genital sites. WHO calls for urgent investment, particularly in national surveillance systems, to support and expand global surveillance of gonococcal antimicrobial resistance.
