New provisional STI surveillance data from the UK Health Security Agency (UKHSA) shows a rise in antibiotic-resistant gonorrhoea cases, including extensively drug-resistant (XDR) strains.
While most gonorrhoea infections can be treated effectively, certain resistant strains present significant treatment challenges. Ceftriaxone-resistant gonorrhoea is of particular concern. As the primary antibiotic used to treat gonorrhoea, resistance to ceftriaxone can make infections difficult to treat.
Since first being detected in England in 2015, 42 cases of ceftriaxone-resistant gonorrhoea have been reported. Fifteen of these cases were extensively drug-resistant (XDR), which means that they were resistant to ceftriaxone and to second line treatment options.
Although numbers remain low, cases are being detected more frequently. In the 15 months from January 2024 to 20 March 2025, there were 17 cases of ceftriaxone resistant gonorrhoea reported (13 in 2024 and 4 in 2025 so far). This compares to 16 across the previous 2 years (January 2022 to December 2023).
XDR cases are also rising. From January 2024 to March 2025 there were 9 XDR cases (6 in 2024 and 3 in 2025 to date). This compares to 5 cases in total in the previous 2 years (between January 2022 and December 2023).
Most cases are linked to travel to or from the Asia-Pacific region, where ceftriaxone resistance is common. While transmission within England has been limited so far, the increasing number of cases in recent years is concerning as it increases the chance of wider spread and treatment challenges.
Typical symptoms of gonorrhoea include a thick green or yellow discharge from the vagina or penis, pain when urinating, pain and discomfort in the rectum and, in women and other people with a uterus or ovaries, lower abdominal pain and bleeding between periods. However, many people infected with gonorrhoea will have no symptoms, especially for infections in the throat, vagina or rectum. This lack of symptoms makes it important to test regularly when having sex with new or casual partners.
Untreated gonorrhoea can lead to serious health complications including infertility and pelvic inflammatory disease (PID), an infection of the female reproductive system, which includes the womb, fallopian tubes and ovaries.
Dr. Katy Sinka, Consultant Epidemiologist and Head of the STI section at UKHSA, said
Gonorrhoea is becoming increasingly resistant to antibiotics, which could make it untreatable in future. If left untreated, it can cause serious problems like pelvic inflammatory disease and infertility.
The best way to stop STIs is by using a condom. If you’ve had condomless sex with a new or casual partner, get tested, whatever your age, gender or sexual orientation. This includes when you are having sex abroad. Early detection not only protects your health but prevents transmission to others. Many STIs show no symptoms, which is why regular testing is so important. Testing is quick, free and confidential.
The latest provisional data on gonorrhoea overall shows approximately 54,965 gonorrhoea diagnoses at sexual health services in the first 9 months of 2024, compared to over 85,000 recorded in the whole of 2023. The latest data indicates that gonorrhoea diagnoses are starting to level, remaining relatively high.
Meanwhile, around 7,000 syphilis cases were recorded between January and September 2024, compared to 9,513 in the whole of 2023. UKHSA reminds healthcare professionals to remain vigilant for syphilis symptoms, as untreated infections can lead to serious, irreversible complications affecting the brain, heart and nerves.
Both gonorrhoea and syphilis are easy to catch. If you are having condomless sex with new or casual partners, regular testing for STIs and HIV is essential to maintain good sexual health. Testing is free and can be accessed through local sexual health clinics, university and college medical centres or through self-sampling kits ordered online and sent discreetly through the post.
