19-05-2025
Azithromycin Resistance Rises in European Gonorrhoea Cases
The 2022 antimicrobial resistance (AMR) data for Neisseria gonorrhoeae from the European Gonococcal Antimicrobial Surveillance Programme (Euro-GASP) indicated a substantial rise in resistance to azithromycin and ciprofloxacin; however, resistance levels for ceftriaxone and cefixime remained low.
METHODOLOGY:
Researchers conducted a retrospective study to examine AMR data from the 2022 Euro-GASP and compared it with the most recently published data from 2016 to 2019 to identify changes in AMR over time.
Overall, 3008 N gonorrhoeae isolates from 23 European countries were analysed for their susceptibility to antimicrobials — ceftriaxone, cefixime, azithromycin, and ciprofloxacin.
isolates from 23 European countries were analysed for their susceptibility to antimicrobials — ceftriaxone, cefixime, azithromycin, and ciprofloxacin. Tests for antimicrobial susceptibility were performed using minimal inhibitory concentration gradient strip tests as per the European Committee on Antimicrobial Susceptibility Testing.
TAKEAWAY:
Gonorrhoea cases among women increased significantly in 2022, rising to 19.2% from 15.8% in 2019 ( P = .0004) and 15.3% in 2016 ( P = .0002); however, cases decreased among men.
= .0004) and 15.3% in 2016 ( = .0002); however, cases decreased among men. A significant increase in azithromycin resistance (24.9% vs 9%; P = .0002) and ciprofloxacin resistance (65.8% vs 57.4%; P = .0002) was observed in 2022 vs 2019.
= .0002) and ciprofloxacin resistance (65.8% vs 57.4%; = .0002) was observed in 2022 vs 2019. The risk for azithromycin resistance increased by nearly threefold in men who have sex with men (odds ratio, 2.85; P = .0040).
= .0040). Cefixime resistance declined from 0.8% in 2019 to 0.3% in 2022 ( P = .014), with higher cases observed among women. Ceftriaxone resistance remained low at 0.03% in 2022, similar to that seen in previous years.
IN PRACTICE:
"The only long-term solution for effective management and control of gonorrhoea is likely a gonococcal vaccine," the authors wrote.
SOURCE:
This study was led by Susanne Jacobsson, WHO Collaborating Centre for Gonorrhoea and Other STIs, Örebro University, Örebro, Sweden. It was published online on May 10, 2025, in The Lancet Regional Health - Europe .
LIMITATIONS:
This study faced issues with insufficient coverage and incomplete reporting of epidemiologic and clinical variables, with a predominance of urogenital specimens and limited samples from anorectal and oropharyngeal sites.
DISCLOSURES:
This study was supported by the European Centre for Disease Prevention and Control (ECDC). The ECDC had a Framework Service Contract with Örebro University Hospital to coordinate the Euro-GASP. The UK Health Security Agency was subcontracted for this study. The authors reported having no conflicts of interest.
