Data from the UK Health Security Agency (UKHSA) shared in August 2024 reveals a “concerning rise” in antibiotic-resistant gonorrhoea infections in England. In 2023 over 85,000 gonorrhoea diagnoses were reported in England; this is the highest number since records began in 1918. There were also 15 confirmed cases of infection with ceftriaxone-resistant Neisseria gonorrhoeae detected in England between June 2022 and May 2024. Since the initial case detected in England in 2015, there have been a total of 31 ceftriaxone-resistant Neisseria gonorrhoeae cases. UKHSA highlights the importance of “regular” STI testing, particularly for people who have “condomless sex with new or casual partners”.
Developing resistance
Gonorrhoea is the second most commonly diagnosed sexually transmitted infection (STI) in England. In 2023 the highest annual number of diagnoses (85,223) since records began was reported. The bacteria, Neisseria gonorrhoeae, has developed resistance to every class of antibiotics used to treat it. Cephalosporins are the last remaining class of antibiotics available for use as empirical monotherapy. The recommended first-line therapy is 1g ceftriaxone (a cephalosporin), but there are “sporadic” cases of infection with ceftriaxone-resistant N. gonorrhoeae.
16 cases were reported between 2015 and May 2022; since then, a further 15 ceftriaxone-resistant infections have been detected in England. Five of these recent cases were extensively drug-resistant (XDR). All 31 cases detected in England have been among heterosexual individuals, mostly in their 20s, and “most” have acquired infection in the Asia-Pacific region, which is the region with the highest prevalence of ceftriaxone-resistance.
UKHSA response
UKHSA has sent a clinical alert to sexual health services to “reinforce the need” to culture gonococcal isolates, perform test-of-cure, and refer all ceftriaxone-resistant N. gonorrhoeae strains or potential treatment failures to UKHSA. It also emphasises the importance of correct and consistent condom use to the public.
Dr Helen Fifer, Consultant Microbiologist at UKHSA, highlighted a concern that gonorrhoea could become “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 (BASHH) described the rise of these antibiotic-resistant infections as 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.”
Professor Phillips stated that BASHH and sector partners have “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.”
In January 2024 CARB-X announced funding for Intravacc’s vaccine efforts against gonorrhoea, which you can read about here. We also look forward to further exploring the role of vaccines in addressing the growing challenge of N. gonorrhoeae at the Congress in Barcelona this October, so get your tickets to join us there, and don’t forget to subscribe to our weekly newsletters here.
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