Gonorrhoea has developed resistance to one antibiotic after another over decades. Ceftriaxone is the current first-line treatment in the UK, and cases resistant to it are now being detected.
UKHSA reported 14 cases of ceftriaxone-resistant gonorrhoea in the first five months of 2025 — already more than the 13 recorded across the whole of 2024. The absolute numbers are small. The direction is what concerns public health services.
Why Gonorrhoea in Particular
Neisseria gonorrhoeae acquires resistance unusually readily — it takes up genetic material from other bacteria and holds onto changes that help it survive antibiotics. It has already defeated penicillin, tetracyclines, ciprofloxacin and azithromycin as reliable first-line options.
Each time, treatment moved to the next drug. Ceftriaxone is a long way down that list, and the list is not infinite.
What Resistance Means for a Patient
If you have a resistant infection, standard treatment may not clear it. That means:
- A test of cure after treatment, which is why sexual health services ask you to come back
- Alternative antibiotics, sometimes given intravenously
- Specialist input, and detailed partner notification
- Public health follow-up, because resistant cases are tracked individually
Most cases identified in the UK have been linked to infection acquired abroad, particularly in the Asia-Pacific region, though transmission within the UK has also been documented.
Why the Test of Cure Matters
With most infections, treatment ends the episode. With gonorrhoea, the follow-up test is how resistant infection gets caught before it spreads. Skipping it because you feel fine is understandable and is precisely the wrong response — resistant gonorrhoea can be asymptomatic while still transmissible.
If you have been asked to return for a test of cure, go.
How Resistance Is Slowed
- Preventing infections, which is where the 4CMenB vaccination programme comes in — every infection averted is an antibiotic course not given
- Correct treatment, at the right dose, in a service that can test for resistance
- Partner notification, so an infection is not passed back after treatment
- Avoiding self-treatment with antibiotics bought online, which is a reliable way to produce partially treated infection — the ideal conditions for resistance
That last point is worth emphasising. Antibiotics bought without diagnosis, at unknown doses, for an infection that may not be what you think it is, is the exact scenario resistance thrives on.
The DoxyPEP Tension
The UK's doxyPEP guidance recommends doxycycline after sex to prevent syphilis. Its effect on gonorrhoea is limited, because tetracycline resistance in gonorrhoea is already widespread, and one of the objections to the strategy is that wider antibiotic exposure could worsen resistance further.
This is being monitored rather than assumed either way, and it is a genuine open question rather than a settled one.
What to Do
Test regularly if you are at risk, particularly for throat and rectal infection, which are often asymptomatic and are frequently where resistant strains are found. Complete any treatment given. Attend the test of cure. Tell partners.
None of this is new advice. What has changed is the cost of not following it.