ECDC warns drug-resistant gonorrhoea spreads in Europe

Antibiotic-resistant gonorrhoea is being detected more often across Europe, and the European Centre for Disease Prevention and Control says the pattern is shifting from sporadic, travel-linked cases to signs of local transmission. According to Euronews, the ECDC points to rising case numbers in several countries since 2025, including France, Germany, Sweden and the United Kingdom, alongside evidence that resistant strains are circulating within European sexual networks.

The warning lands on top of a broader surge in gonorrhoea notifications. The ECDC says reported gonorrhoea rates in the European region have risen sharply over the past decade, and that 2024 brought the highest number of confirmed cases since EU surveillance began in 2009. The agency also notes a basic complication for interpreting those totals: expanded screening and more complete reporting can make case curves climb even if underlying transmission changes less.

Resistance, however, is not a reporting artefact. The ECDC’s concern is that Neisseria gonorrhoeae is becoming less responsive to the main therapies used in routine care, particularly ceftriaxone and, where used, combinations with azithromycin. When first-line treatment becomes less reliable, each missed cure is not just an individual failure but an extra opportunity for onward spread, because patients often remain infectious while symptoms are mild or absent.

Europe’s exposure is described as a mix of importation and local amplification. The ECDC still sees importation from outside Europe as the principal route by which ceftriaxone-resistant strains arrive, with parts of Southeast Asia cited as major sources of resistant lineages that have spread internationally. But once a strain is present, local transmission determines whether it stays a clinical oddity in specialist clinics or becomes a routine problem for primary care.

The risk is unevenly distributed. The ECDC assesses the risk to the general sexually active population as low, while placing higher risk on people with multiple or frequently changing partners and those having condomless sex with new or casual partners. In 2024, the agency says transmission among men who have sex with men accounted for a majority of reported cases, with heterosexual transmission accounting for most of the remainder.

The next constraint is capacity: resistant gonorrhoea is only visible where laboratories test for it and systems report it. The ECDC is effectively asking countries to pay for surveillance now, before treatment failures become common enough to show up in emergency departments and fertility clinics.

For the moment, Europe still has a standard injectable antibiotic that usually works. The ECDC’s update is that the continent is starting to see what happens when that assumption is treated as permanent.