The European Centre for Disease Prevention and Control (ECDC) has issued a stark warning: antibiotic-resistant gonorrhea is no longer a problem confined to travelers returning from abroad. Instead, the agency reports growing evidence of local transmission across several European Union member states, marking a significant shift in the epidemiology of this sexually transmitted infection.
Initially, cases of drug-resistant Neisseria gonorrhoeae were sporadic and typically linked to travel outside Europe. But since 2025, the pattern has changed. France, Germany, Sweden, and the United Kingdom have all reported notable increases in resistant infections, while other countries continue to detect isolated cases. The ECDC now assesses that local spread is underway, raising alarms about the future effectiveness of standard treatments.
Local Transmission: A Warning Sign
Csaba Ködmön, an ECDC microbiology expert, described the situation bluntly: “Local transmission of drug-resistant gonorrhoea in Europe is a warning sign we should not ignore.” He added that while the risk to the general population remains low for now, “growing resistance reduces the effectiveness of the therapies we rely on today.” If resistant strains continue to proliferate, treatment options could become severely limited.
The current standard of care relies on ceftriaxone, often combined with azithromycin. Yet the bacteria are increasingly resistant to both drugs, undermining their efficacy and enabling sustained transmission. The ECDC notes that importation from outside Europe—particularly from Southeast Asian countries such as Cambodia, Indonesia, Thailand, and Vietnam—remains the primary route for ceftriaxone-resistant strains to enter the continent. Some of these imported strains have already caused treatment failures in Europe and North America.
However, the agency warns that the rising number of domestic detections could signal an early phase of expansion. “There is a risk of further escalation if control measures are not implemented and maintained,” the ECDC cautioned.
Gonorrhea is one of the most common bacterial sexually transmitted infections. Left untreated, it can lead to severe complications, including pelvic inflammatory disease, infertility, and ectopic pregnancy. The ECDC’s data show that notification rates across the European region have soared by 303% over the past decade. In 2024 alone, 106,331 confirmed cases were reported—the highest number since EU-wide surveillance began in 2009. Globally, an estimated 82 million new infections occur each year among people aged 15 to 49.
Some of the increase may be attributable to expanded screening and more complete reporting, the ECDC acknowledges. But the trend is clear: between 2023 and 2024, overall rates rose, driven primarily by a 7.9% increase among men, while rates among women fell by 8.6%. The highest rates were observed in men aged 25 to 34 and women aged 20 to 24. Transmission among men who have sex with men accounted for 62% of reported cases in 2024, compared with 37% among heterosexual men and women combined.
The ECDC assesses the risk to the general sexually active population as low, but the agency’s warning underscores the need for vigilance. As antibiotic resistance spreads, Europe faces a growing public health challenge that demands coordinated surveillance, prevention, and treatment strategies.
For context on broader health risks in Europe, see our coverage of wildfire smoke and air quality, and the WHO Europe warning on AI in hospitals.
