By Ayomide Otitoju
The World Health Organization (WHO) has raised alarm over the growing resistance of gonorrhoea to antibiotics, according to new data from its Enhanced Gonococcal Antimicrobial Surveillance Programme (EGASP). The findings, released during World Antimicrobial Resistance (AMR) Awareness Week, highlight the urgent need for strengthened surveillance, improved diagnostics, and equitable access to new treatments for sexually transmitted infections (STIs).
Launched in 2015, EGASP collects laboratory and clinical data from sentinel sites worldwide to monitor drug-resistant gonorrhoea and inform treatment guidelines. Dr Tereza Kasaeva, Director of WHO’s Department for HIV, TB, Hepatitis & STIs, emphasized the importance of integrating gonorrhoea surveillance into national STI programmes, calling it “essential to tracking, preventing, and responding to drug-resistant gonorrhoea and protecting public health worldwide.”
Between 2022 and 2024, resistance to the primary antibiotics for gonorrhoea—ceftriaxone and cefixime—rose sharply, from 0.8% to 5% and 1.7% to 11%, respectively. Resistance to azithromycin remained stable at 4%, while ciprofloxacin resistance reached 95%. Cambodia and Viet Nam reported the highest resistance levels.
In 2024, 12 EGASP countries spanning five WHO regions reported 3,615 gonorrhoea cases, up from just four countries in 2022. These countries include Brazil, Cambodia, India, Indonesia, Malawi, the Philippines, Qatar, South Africa, Sweden, Thailand, Uganda, and Viet Nam.
Over half of all symptomatic cases in men (52%) were reported in the WHO Western Pacific Region, with the Philippines (28%), Viet Nam (12%), Cambodia (9%), and Indonesia (3%) contributing the majority. Countries in the African Region accounted for 28% of cases, South-East Asia 13%, the Eastern Mediterranean 4%, and the Americas 2%. The median patient age was 27 years, with 20% identifying as men who have sex with men and 42% reporting multiple sexual partners in the past 30 days.
WHO strengthened genomic surveillance in 2024, sequencing nearly 3,000 samples from eight countries. Studies on new treatments, including zoliflodacin and gepotidacin, as well as tetracycline resistance, were conducted at WHO’s Collaborating Centre on AMR in Sweden. These efforts aim to guide future gonorrhoea control and doxycycline-based prevention strategies (DoxyPEP).
EGASP expanded its reach with Brazil, Côte d’Ivoire, and Qatar joining the programme, while India will begin implementation and data reporting in 2025 under its National AIDS and STI Control Programme.
Despite progress, WHO warns of funding shortages, incomplete reporting, and data gaps—particularly for women and extragenital infections. The agency calls for urgent investment in national surveillance systems to sustain and expand global efforts against drug-resistant gonorrhoea.
