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Between June 2022 and May 2024, 15 ceftriaxone-resistant gonorrhoea cases were detected in England

New data from the UK Health Security Agency (UKHSA) highlights a concerning rise in antibiotic-resistant gonorrhoea infections in England.   

In 2023, over 85,000 gonorrhoea diagnoses were reported in England, the highest number since records began in 1918. This highlights the importance of regular STI testing, especially if you have condomless sex with new or casual partners. While the infection can usually be easily treated, some strains are resistant to commonly used antibiotics and are harder to treat. A type that poses a particular threat is ceftriaxone-resistant gonorrhoea. Ceftriaxone is the ‘first line’ antibiotic used to treat gonorrhoea in this country and so resistance to the drug can make treatment difficult, especially for gonorrhoea infections in the throat.   

Between June 2022 and May 2024, 15 ceftriaxone-resistant gonorrhoea cases were detected in England, including 5 that were found to be extensively drug-resistant (resistant to both first- and second-line treatment options and to other antibiotics).  Since the first case detected in England in 2015, there have now been a total of 31 ceftriaxone-resistant gonorrhoea cases, 7 of which were extensively drug-resistant.   

To date, all detected cases have been among heterosexual individuals, mostly in their 20s, and most acquired the infection abroad. There has been limited transmission within England, but the increasing number of cases in recent years is concerning as it increases the chance of wider spread and treatment challenges.   

Dr Helen Fifer, Consultant Microbiologist at UKHSA, said:  

Gonorrhoea is becoming increasingly resistant to antibiotics, risking the possibility of it becoming untreatable in the future. Untreated gonorrhoea can lead to serious health issues, including pelvic inflammatory disease and infertility. Condoms are the best defence, but if you didn’t use one with a recent new or casual partner, get tested to detect the infection and prevent onwards transmission.

Professor Matt Phillips, President of the British Association for Sexual Health and HIV, said:  

The rise of antibiotic-resistant gonorrhoea infections in England is a worrying trend that must be addressed with immediate action. Antibiotic resistance of STIs poses an increasingly major public health threat, which can create physical and psychological harms and place additional demands on other parts of the NHS. BASHH, alongside sector partners, has repeatedly called for a sexual health strategy for England; this must be a priority if our expert sexual health workforce are to effectively meet these growing and changing needs in sexual health.

Meanwhile, the latest data from UKHSA show that syphilis rates are still rising. Syphilis can cause severe, irreversible, and potentially life-threatening damage to the brain, heart, or nerves if not treated. In 2023, diagnoses of infectious syphilis rose to 9,513, a 9.4% increase from 2022 (8,693). The highest rates were among gay, bisexual and other men who have sex with men, however, the largest proportional rise between 2022 and 2023 was in heterosexual individuals. UKHSA is also reminding healthcare professionals to be alert to the signs of syphilis, because it can cause a range of symptoms affecting multiple organ systems and, without treatment, can lead to serious and permanent harm.   

While the increase in gonorrhoea and syphilis diagnoses will in part be due to increases in testing, it may also be due to more transmission of these STIs within the population.  

Both of these STIs are easy to catch and are on the rise. 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 sent discreetly through the post.