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Home News centre National Press Releases 2012 Press Releases ›  Gonorrhoea treatment resistance risk falls but new diagnoses rise

Gonorrhoea treatment resistance risk falls but new diagnoses rise

12 September 2012

Latest Health Protection Agency (HPA) surveillance figures - released today at the Health Protection 2012 conference - indicate that, for the first time in five years, the risk of resistance developing in currently recommended gonorrhoea treatments fell slightly in 2011.

However, experts urge continued vigilance as new diagnoses of gonorrhoea rose 25 per cent in the same year, to nearly 21,000 cases, as reported by the HPA in May 2012. Today’s findings remain a cause of concern as, of the gonorrhoea diagnoses looked at, nearly one third were repeat cases and one third were diagnosed alongside another sexually transmitted infection (STI).

Encouragingly, following the publication of new prescribing guidelines in 2011, the surveillance found broad adherence by GUM clinics. As recommended by the British Association of Sexual Health and HIV (BASHH), nearly all patients (93 per cent) received ceftriaxone first-line treatment, up 53 per cent from 2010.

Professor Cathy Ison, leading the HPA gonorrhoea resistance surveillance programme, said: “We were pleased to see such a rapid change in prescribing practice and are cautiously optimistic about what the 2011 surveillance data show. Ensuring resistant strains do not persist and spread remains a major public health concern. It is more important than ever we diagnose gonorrhoea promptly, adhere to treatment guidelines and identify and manage any cases of potential treatment failure effectively. If not, the threat of untreatable gonorrhoea in the future is very real.”

Laboratory testing of the two first-line antimicrobial treatments showed the drift towards potential ceftriaxone treatment resistance seen over previous years had reversed, and azithromycin resistance had stayed steady (0.5 per cent).

Testing cefixime, the second in the line of defence, also showed a decline in resistance risk for the first time since 2007. For all three antibiotics the risk of a potentially resistant infection with was higher (or most apparent) among MSM.

Dr Gwenda Hughes, head of STI surveillance at the HPA, said: “The 25 per cent increase in new gonorrhoea diagnoses in 2011, plus high rates of repeat infection and co-infection with other STIs, shows more must be done to encourage safer sexual behaviour through health promotion and ensuring easy access to sexual health services and screening.”

To combat the continuing high rates of STI transmission in England, and the growing risk of gonorrhoea treatment resistance it is essential to always use a condom when having sex with casual and new partners, and to get tested regularly if you are in one of the highest risk groups (e.g. young adults or men who have sex with men). Getting screened for HIV / STIs can lead to early identification and treatment, as often these infections have no symptoms. In addition, reducing the number of sexual partners and avoiding overlapping sexual relationships can reduce the risk of being infected with an STI.


Notes for editors:

  • For more information please contact the national HPA press office at Colindale on 0208 327 7901 or email Out of hours: 0208 200 4400.
  • Worldwide gonorrhoea strains showing decreased susceptibility, including cefixime and ceftriaxone treatment failures, have been reported. The Gonococcal Resistance to Antimicrobial Surveillance Programme (GRASP) was established in 2000. It is a national sentinel surveillance programme monitoring trends and drifts in susceptibility to antimicrobial agents used for treatment of gonorrhoea. It comprises 26 genitourinary medicine (GUM) clinics, linked to 24 laboratories that refer all isolates from consecutive patients over a three-month period annually for centralised susceptibility testing. See the HPA Antimicrobial Resistance Data - Gonorrhoea page for more information. 
  • GRASP 2011:
    • Samples collected from 24 clinics in England and Wales across July – September 2011.
    • 1,359 confirmed gonorrhoea samples from 1,534 isolates submitted.
    • Characteristics of patients diagnosed with gonorrhoea:
      • Almost 40 per cent aged between 25 – 34 years old
      • Men who have sex with men (49 per cent), heterosexual men (28 per cent), women (23 per cent)
      • Over 95 per cent of samples submitted from GUM clinics, with 50 percent from London patients.
  • The updated UK national guideline for the management of gonorrhoea in adults was published by the British Association of Sexual Health and HIV in May 2011, Int J STD AIDS. 2011;22(10):541-547. The GRASP 2011 data showed a 53 per cent increase in ceftriaxone and a 45 per cent drop in cefixime prescribing, as recommended.
  • The increase in new gonorrhoea diagnoses seen between 2010 and 2011 may be partially attributed to increased screening for extra genital infection (especially pharyngeal infection) in high risk groups and increased use of more sensitive nucleic acid amplification tests (NAATs) for the diagnosis of gonorrhoea. See the HPA Annual STI 2011 data press release for more information. 
  • The Health Protection Agency is an independent UK organisation that was set up by the government in 2003 to protect the public from threats to their health from infectious diseases and environmental hazards. In April 2013 the Health Protection Agency will become part of a new organisation called Public Health England, an executive agency of the Department of Health. To find out more, visit our website: or follow us on Twitter @HPAuk.

Last reviewed: 12 September 2012