Provisional data on diagnoses of gonorrhoea, syphilis (January 2019 to June 2024) and ceftriaxone resistant gonorrhoea (all diagnoses to end of December 2024) in England
Published 13 February 2025
Applies to England
© Crown copyright 2025
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Diagnoses of gonorrhoea and syphilis in England
Main points
There were an estimated 17,530 diagnoses of gonorrhoea at sexual health services in England in quarter 2 (April to June) 2024, down from 19,165 in the previous quarter. This shows a continuation of a downward trajectory since quarter 2 2023, although numbers remain relatively high.
Diagnoses of syphilis at sexual health services in England also decreased slightly in quarter 2, 2024 to an estimated 2,300, down from 2,360 in the previous quarter. Diagnoses of syphilis appear to be levelling.
Background information
There has been an increasing trend in gonorrhoea and syphilis diagnoses since the early 2000s. A marked but temporary decline in diagnoses of both infections was seen during 2020 and 2021 largely explained by a fall in testing during disruption to sexual health services caused by the COVID-19 pandemic. Figures 1a and 1b show provisional data on diagnoses of gonorrhoea and infectious syphilis (primary, secondary and early latent stages) in England. These provisional quarterly figures will likely be an undercount but can be used to monitor indicative trends in the data and are more timely than the annual STI official statistics and the indicators on the Sexual and Reproductive Health Profiles. The annual data will be published around 6 months after the end of the data collection year with more complete figures and additional breakdowns.
Please also see the Sexual and reproductive health in England: local and national data guide for other presentations of data on STIs.
Figure 1a. Provisional data on diagnoses of gonorrhoea in England by quarter, January 2019 to June 2024
Figure 1b. Provisional data on diagnoses of infectious syphilis [note 2] in England by quarter, January 2019 to June 2024
Source: GUMCAD STI Surveillance System.
Note 1: data for the most recent quarters in 2024, shown in the shaded part of the graph, are likely to increase as delayed data submissions are received. To account for uncertainty in this provisional data, the data points have been rounded to the nearest 10.
Note 2: infectious syphilis refers to primary, secondary and early latent stages.
Ceftriaxone-resistant Neisseria gonorrhoeae in England
Main points
Ceftriaxone resistant Neisseria gonorrhoeae (the bacteria that causes gonorrhoea) was first detected in England in 2015. By end of December 2024, a total of 38 cases had been reported in England, 12 of which were extensively drug-resistant (XDR) (Figure 2).
The frequency of detecting ceftriaxone-resistant Neisseria gonorrhoeae has increased with 29 cases, including 11 XDR cases, being detected since the start of 2022.
Background information
Neisseria gonorrhoeae has developed resistance to every class of antibiotics used to treat it, and cephalosporins are the last remaining class of antibiotics available for use as empirical monotherapy. The currently recommended first-line therapy is 1g ceftriaxone (a cephalosporin) and, while the vast majority of gonorrhoea cases in England are susceptible to ceftriaxone, sporadic cases of ceftriaxone-resistant N. gonorrhoeae are detected in England. Most ceftriaxone-resistant cases are associated with travel to or from the Asia-Pacific region, where the prevalence of ceftriaxone-resistance is high.
Guidance is available on the management of ceftriaxone resistant gonorrhoea. Suspected ceftriaxone treatment failures should be reported to UK Health Security Agency (UKHSA) via the ‘Gonorrhoea treatment failure report form’ on the HIV and STI Data Exchange. For any queries, please contact grasp.enquiries@ukhsa.gov.uk
Ceftriaxone-resistant isolates should be referred to the UKHSA sexually transmitted infections reference laboratory (STIRL). Annual data on trends in antimicrobial resistance and decreased susceptibility in gonococcal infection in England and Wales are published in the Gonococcal resistance to antimicrobials surveillance programme (GRASP) report.
Figure 2. Number of cases of infection with ceftriaxone-resistant Neisseria gonorrhoeae in England, 2015 to end of December 2024
Source: Referrals to the STIRL at the UKHSA from sexual health services in England.
Note 3: extensively drug-resistant (XDR) infections are defined as resistant to both first and second line treatment options and to other antibiotics.