Three more cases of ceftriaxone-resistant gonorrhoea in England have been confirmed by the UK Health Security Agency (UKHSA). This follows a single case in a heterosexual man in his 20s reported in London in December, the first since 2019.
Resistance of N gonorrhoeae to antibiotics has been increasing for years and ceftriaxone is now the standard first-line therapy since gonorrhoea has become treatment-resistant to other antibiotics. Ceftriaxone-resistance has been rare in the UK until now, though it is common in the Asia-Pacific region.
The new cases involve a woman in her 20s also in London and a heterosexual couple in their 20s based in the Midlands. There are no known connections between the London and Midlands individuals. All three individuals have been diagnosed with a ceftriaxone-resistant strain of N. gonorrhoeae and it is not yet known whether treatment has been successful – follow-up tests are still awaited. The December patient was successfully treated and subsequently tested negative.
The new cases were detected by antimicrobial susceptibility testing, which is performed routinely for all samples from cases diagnosed as gonorrhoea. Any suspected cases of ceftriaxone-resistant gonorrhoea are then referred to the reference laboratory at the UKHSA for confirmation.
If ceftriaxone treatment fails, the British Association for Sexual Health and HIV (BASHH) gonorrhoea guideline gives advice on alternative antibiotic therapies. This varies on a case-by-case basis depending on the clinical presentation and the antibiotic susceptibility profile of the strains of gonorrhoea found.
Dr Katy Sinka, STI section head at the UK Health Security Agency (UKHSA), said: "After a couple of years without any cases of this hard-to-treat form of gonorrhoea, we have now seen four cases in the last 2 months. It’s too soon to say whether this will be the start of a longer-term trend, but we do know that STIs are on the rise in general."
She issued a warning to the public that treating gonorrhoea as soon as possible is very important to avoid serious long-term health problems including pelvic inflammatory disease, ectopic pregnancy and infertility.
UKHSA actively monitors the spread of antibiotic resistance and implements prompt public health action to limit further spread. Further investigations into the outbreak are now underway.