Research and analysis

Quarterly report on diagnoses of syphilis, gonorrhoea and ceftriaxone-resistant gonorrhoea in England: provisional data, February 2025

Updated 27 March 2025

Applies to England

Interpretation notes are available for the provisional data on diagnoses of syphilis and gonorrhoea data in England.

Diagnoses of syphilis and gonorrhoea from January 2019 to June 2024

Main points

Diagnoses of infectious syphilis (primary, secondary and early latent stages) at sexual health services in England decreased slightly in quarter 2 (April to June) 2024 to an estimated 2,300, down from 2,360 in the previous quarter. Diagnoses of syphilis appear to be levelling.

There were an estimated 17,530 diagnoses of gonorrhoea at sexual health services in England in quarter 2 2024, down from 19,165 in the previous quarter. This shows a continuation of a downward trajectory since quarter 2 (April to June) 2023, although numbers remain relatively high.

Background information

There has been an increasing trend in infectious syphilis and gonorrhoea 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 infectious syphilis and gonorrhoea 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 infectious syphilis [note 1] in England by quarter, January 2019 to June 2024

Figure 1b. Provisional data on diagnoses of gonorrhoea in England by quarter, January 2019 to June 2024

Source: GUMCAD STI Surveillance System.

Note 1: infectious syphilis refers to primary, secondary and early latent stages.

Note 2: 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.

All diagnoses of ceftriaxone-resistant Neisseria gonorrhoeae to end of December 2024

Main points

Ceftriaxone resistant Neisseria gonorrhoeae (the bacterium 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, January 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.