Gonococcal antimicrobial susceptibility surveillance in the European Union/European Economic Area

The 2023 European Gonococcal Antimicrobial Surveillance Programme (Euro-GASP) monitored antibiotic resistance in Neisseria gonorrhoeae across 24 EU/EEA countries under ECDC coordination. A total of 3,184 isolates were analyzed, mostly from male patients (83%) with a median age of 30 years. Samples were primarily genital, but rectal and pharyngeal sites were also common.

Antimicrobial testing revealed that one extensively drug-resistant isolate (resistant to ceftriaxone, cefixime, azithromycin, ciprofloxacin, and tetracycline) was detected in France. Cefixime resistance remained low at 0.2%, while ceftriaxone resistance was extremely rare but still concerning. Azithromycin resistance (MIC > 1 mg/L) affected 23.2% of isolates, slightly lower than in 2022, yet high-level azithromycin resistance (MIC ≥ 256 mg/L) increased to 1.2%. Ciprofloxacin resistance decreased slightly to 63%, and tetracycline resistance remained high at 58%.

Although dual resistance to ceftriaxone and azithromycin is still uncommon, rising azithromycin resistance and sporadic ceftriaxone-resistant strains pose a serious public health risk. Current EU guidelines recommend high-dose ceftriaxone monotherapy or combination with azithromycin. Continuous quality-assured surveillance and the development of new treatment options are crucial to ensure gonorrhoea remains treatable in Europe.