The World Health Organization (WHO) has issued a new warning following evidence that antimicrobial-resistant gonorrhoea is advancing rapidly across several parts of the world, including Africa, according to updated findings from its Enhanced Gonococcal Antimicrobial Surveillance Programme (EGASP).
The figures were released during World Antimicrobial Resistance Awareness Week, underscoring the growing international urgency to address the escalating threat posed by drug-resistant sexually transmitted infections.

Countries in Africa Among Those Reporting Increased Resistance

According to WHO, multiple countries — including several in the WHO African Region — have recorded rising levels of resistance to the main antibiotics currently used to treat gonorrhoea.
Between 2022 and 2024, resistance to ceftriaxone, one of the most widely recommended treatments, surged from 0.8% to 5%, while resistance to cefixime rose from 1.7% to 11%. Resistance to ciprofloxacin remained particularly concerning, reaching 95% globally.

The WHO notes that resistant strains are being identified in an increasing number of nations, with the highest rates documented in Cambodia and Viet Nam.

Growing Participation in Global Surveillance Programmes

EGASP, established by WHO in 2015, has expanded significantly. In 2024, 12 countries across five WHO regions contributed laboratory and clinical data — up from only four countries in 2022.
Participating nations include Brazil, Cambodia, India, Indonesia, Malawi, the Philippines, Qatar, South Africa, Sweden, Thailand, Uganda and Viet Nam, collectively reporting 3,615 confirmed cases of gonorrhoea.

Countries in the WHO African Region accounted for 28% of symptomatic male cases, highlighting the public health burden within the continent.

Demographic Trends Reveal High-Risk Patterns

The median age of patients recorded across the participating countries was 27 years, with cases spanning individuals aged 12 to 94.
Among those identified, 20% were men who have sex with men, and 42% reported having multiple sexual partners in the preceding month. Nearly one in five had recently travelled, and 8% reported prior antibiotic use — factors recognised in scientific literature as contributors to antimicrobial resistance.

More than half of all symptomatic male cases originated from the WHO Western Pacific Region, particularly the Philippines, Viet Nam, Cambodia and Indonesia.

Advances in Genomic Surveillance and New Treatment Research

WHO has intensified its genomic sequencing efforts, analysing nearly 3,000 samples from eight countries in 2024.
In partnership with its Collaborating Centre on AMR in Sexually Transmitted Infections, Sweden contributed research on emerging treatments such as zoliflodacin and gepotidacin, alongside studies on tetracycline resistance. These developments may eventually inform future global strategies, including the use of doxycycline-based prevention (DoxyPEP).

The expansion of EGASP continued, with Brazil, Côte d'Ivoire and Qatar formally joining the programme and India preparing to integrate surveillance activities in 2025.

Persistent Challenges Undermine Global Response Capacity

Despite progress, the WHO stresses that major obstacles remain. Key issues include:

  • Insufficient funding

  • Incomplete data submission

  • Limited representation of women and extragenital infection sites

  • Weak surveillance infrastructure in several regions, including parts of Africa

Dr Tereza Kasaeva, Director of the WHO Department for HIV, TB, Hepatitis & STIs, reiterated that comprehensive monitoring systems are essential for protecting public health. She emphasised the need for all countries to strengthen national STI programmes and prioritise gonorrhoea surveillance.

A Call for Immediate International Action

The updated findings demonstrate that antimicrobial-resistant gonorrhoea is no longer an emerging threat but a firmly established global health challenge. Countries across Africa, Asia, Europe and the Americas are urged to increase investment in diagnostics, bolster laboratory capacity and ensure access to new therapeutic options as they become available.

WHO concludes that only coordinated international action can slow the progression of drug-resistant sexually transmitted infections and safeguard future treatment effectiveness.