Since 2022, a growing number of European countries have reported cases of gonorrhea caused by ceftriaxone-resistant Neisseria gonorrhoeae, including multidrug-resistant (MDR) and extensively drug-resistant (XDR) strains.
Although initially cases were sporadic and frequently associated with travel, particularly to Southeast Asia, an increase in cases and growing evidence of local transmission in Europe was observed during 2025 and 2026. France, Germany, Sweden, and the United Kingdom reported the most significant increases.
The ECDC currently considers the risk low for the general population, low-to-moderate for individuals with multiple sexual partners or who have unprotected sex with new or casual partners, and moderate for travelers who engage in risky sexual practices in areas with higher circulation of resistant strains.
Although all reported cases to date have been treatable, sustained transmission of these strains could significantly reduce the effectiveness of first-line treatments. The ECDC recommends strengthening surveillance through culture, antimicrobial susceptibility testing, and genomic surveillance.
