UK health officials say cases of drug-resistant gonorrhea are rising in England, including extensively drug-resistant (XDR) strains.

According to provisional data published today by the UK Health Security Agency (UKHSA), 17 cases of ceftriaxone-resistant gonorrhea were reported from January 2024 to March 20, 2025, compared with 16 in all of 2022 and 2023. The first case of ceftriaxone-resistant gonorrhea in England was detected in 2015.

Nine cases of XDR gonorrhea, which is also resistant to azithromycin, were reported over the same period, compared with five XDR cases in 2022 and 2023.

In England and elsewhere, ceftriaxone is the guideline-recommended first-line antibiotic, and the last remaining effective antibiotic option, for gonorrhea infections. Azithromycin is the second-line treatment and sometimes used in combination with ceftriaxone.

UKHSA says most cases are linked to travel to or from the Asia-Pacific region, where ceftriaxone resistance is common, and that transmission of resistant gonorrhea within England has been limited so far.

"Gonorrhoea is becoming increasingly resistant to antibiotics, which could make it untreatable in future," Katy Sinka, MSc, head of the sexually transmitted infection section at UKHSA, said in a news release. If left untreated, it can cause serious problems like pelvic inflammatory disease and infertility.