WHO global gonococcal antimicrobial surveillance programmes, 2019-22: a retrospective observational study
Magnus Unemo1, Monica M Lahra2, Michelle J Cole3
1WHO Collaborating Centre for Gonorrhoea and other STIs, Department of Laboratory Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden; Institute for Global Health, University College London, London, UK.
The Lancet. Microbe
|September 27, 2025
Summary
Gonococcal antimicrobial resistance (AMR) is a growing global threat. WHO surveillance shows increasing resistance to key antibiotics like ceftriaxone and azithromycin, necessitating urgent public health action to preserve treatment options.
Area of Science:
- Public Health
- Microbiology
- Infectious Diseases
Background:
- Gonorrhoea and its antimicrobial resistance (AMR) are significant global health challenges.
- Enhanced, quality-assured global surveillance of gonococcal AMR is critical for informing treatment guidelines and public health strategies.
Purpose of the Study:
- To report on global gonococcal AMR surveillance data collected by the World Health Organization (WHO).
- To discuss necessary actions to maintain effective gonorrhoea treatment capabilities.
Main Methods:
- Retrospective observational study analyzing gonococcal AMR data from 77 countries (Jan 2019–Dec 2022).
- Minimum inhibitory concentrations of key antimicrobials (ceftriaxone, cefixime, azithromycin, ciprofloxacin) were tested.
- Resistance breakpoints followed European Committee on Antimicrobial Susceptibility Testing or Clinical Laboratory and Standards Institute guidelines.
Main Results:
- High rates of resistance were reported globally: 99% for ciprofloxacin, 88% for azithromycin, 50% for cefixime, and 39% for ceftriaxone.
- Increasing resistance to azithromycin, ceftriaxone, and cefixime was observed, particularly in the WHO Western Pacific region.
- Surveillance remains inadequate in several regions, including Central America, the Caribbean, Eastern Europe, and parts of Africa, the Eastern Mediterranean, and South-East Asia.
Conclusions:
- WHO's global AMR surveillance is expanding and improving with standardization and quality assurance.
- Evidence-based data from surveillance inform management guidelines and public health policies.
- Improvements in prevention, diagnosis, treatment, surveillance, and antimicrobial stewardship are essential to combat gonococcal AMR.
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