No 35b - 2026

Gonorrhoea 2025

In 2025, 5,134 cases of gonorrhoea were registered among 343,224 testing episodes in Denmark.

The trend differed between the different transmission groups. The number of cases among men who have sex with men (MSM) continued in the upward trend that has been observed in recent years.

Among heterosexuals, by contrast, there were signs of stabilisation following the substantial increase in 2022. Particularly among younger heterosexuals, the number of cases decreased compared with the previous year.

The continued increase among MSM reflects that gonorrhoea continues to circulate intensively in this group. At the same time, the trend among heterosexuals suggests that the sharp increase observed after the COVID-19 pandemic may be subsiding.

A more detailed account of gonorrhoea in 2025 can be found in the annual report.

Gonorrhoea acquired abroad

In 2025, information on country of infection was available for 4,013 gonorrhoea episodes. Of these, 338 (8%) were reported as having been acquired abroad, compared with 10% in 2024.

The cases were distributed across 53 different countries. The most frequently reported countries of infection were Spain, Germany, Thailand, Sweden and the United Kingdom.

A larger proportion of gonorrhoea episodes among men were acquired abroad (10%) compared with women (5%). Among MSM, 10% of cases were acquired abroad, while the corresponding proportion among men who have sex with women (MSW) was 9%.

Although a smaller proportion of cases were acquired abroad than in the previous year, imported gonorrhoea remains an important source of introduction of antibiotic-resistant gonococci. When gonorrhoea acquired abroad is suspected, it is therefore particularly important that culture is performed and that the isolate is submitted for antimicrobial susceptibility testing. At the same time, it is also important that the episode is reported in SEI2 with information on the presumed country of infection.

Antimicrobial resistance in Denmark and international developments

Surveillance of antimicrobial resistance showed changes in the resistance pattern compared with 2024. The proportion of isolates resistant to azithromycin increased from 3.6% in 2024 to 8.9% in 2025. At the same time, ciprofloxacin resistance decreased from 60% to 54%.

Particularly among MSM, an increase was observed in the number of isolates with simultaneous resistance to both ciprofloxacin and azithromycin. The combination of resistance to several classes of antibiotics reduces treatment options and underlines the need for close microbiological surveillance.

The number of bacterial sexually transmitted infections continues to increase in Europe, and gonorrhoea remains a significant public health problem. Earlier in 2026, ECDC reported record-high rates of bacterial sexually transmitted infections in Europe, while the development of antimicrobial resistance in Neisseria gonorrhoeae continues to give cause for concern.

In July 2026, ECDC published a follow-up to the European response plan for the management of multidrug-resistant and extensively drug-resistant gonorrhoea. The report concludes that several countries have strengthened their treatment guidelines and preparedness, but that laboratory capacity for culture and antimicrobial susceptibility testing has simultaneously been reduced in a number of countries. ECDC therefore recommends increased microbiological surveillance, systematic antimicrobial susceptibility testing, rapid management of treatment failures and strengthened partner notification.

In EPI-NEWS 41/2025, the treatment recommendation was changed so that the recommended dose of ceftriaxone for uncomplicated gonorrhoea was increased from 500 mg to 1 g. The purpose of the dose change was to ensure sufficient antibiotic exposure and thereby reduce the risk of selection and spread of ceftriaxone-resistant gonococci. This is in line with the latest reports from ECDC on the increase in bacterial sexually transmitted infections in Europe, as well as ECDC’s risk assessment published on 13 July 2026, which emphasised that a concerning increase in ceftriaxone-resistant gonococci is being observed in Europe. France, Germany, Sweden and the United Kingdom in particular (the same countries from which imported gonorrhoea cases were seen in Denmark last year), but also other countries, have reported an increasing number of cases. Imported cases, particularly from Southeast Asia, are an important source of concern, but domestic transmission chains indicate that transmission has also occurred within Europe.

Continued surveillance of resistance trends is therefore essential in order to prevent treatment failure at an early stage and adapt national treatment recommendations. In addition, follow-up testing after completion of treatment is important in order to identify asymptomatic treatment failure.

Global efforts to develop new antibiotics have likewise intensified. In 2018, WHO established a non-profit organisation, the Global Antibiotic Research and Development Partnership (GARDP), with the aim of promoting the development of new antibiotics against resistant bacteria. In December 2025, the US Food and Drug Administration (FDA) approved zoliflodacin as the first new antibiotic for the treatment of uncomplicated gonorrhoea in several decades. The approval represents an important advance, but at the same time underlines the need to preserve the effectiveness of both existing and new antibiotics through rational use and effective resistance surveillance.

Conclusion

The occurrence of gonorrhoea in Denmark in 2025 was characterised by a continued increase among MSM, while the trend among heterosexuals appears to have stabilised and the occurrence among younger heterosexuals decreased. At the same time, the prevalence of azithromycin resistance increased considerably, and more isolates among MSM showed combined resistance to ciprofloxacin and azithromycin. This may be related to the fact that azithromycin is unfortunately still widely used in the treatment of chlamydia.

The trend in Europe points towards an increase in bacterial sexually transmitted infections, as well as a concerning increase in multidrug-resistant gonococci.

These developments underline the importance of continued prevention, targeted testing, as well as culture and antimicrobial susceptibility testing, particularly when infection acquired abroad is suspected, especially Cambodia and Vietnam in Southeast Asia. Strong national resistance surveillance is essential in order to preserve effective treatment options and limit the spread of resistant gonococci.

(T.R. Pedersen, S. Hoffmann, Department of Bacteria, Parasites & Fungi, C. Eves, S. von Schreeb, M. Wessman, Department of Infectious Disease Epidemiology and Prevention)