Quarterly report on diagnoses of syphilis, gonorrhoea and ceftriaxone-resistant gonorrhoea in England: provisional data, March 2025
Updated 27 March 2025
Applies to England
© Crown copyright 2025
This publication is licensed under the terms of the Open Government Licence v3.0 except where otherwise stated. To view this licence, visit nationalarchives.gov.uk/doc/open-government-licence/version/3 or write to the Information Policy Team, The National Archives, Kew, London TW9 4DU, or email: psi@nationalarchives.gov.uk.
Where we have identified any third party copyright information you will need to obtain permission from the copyright holders concerned.
This publication is available at https://www.gov.uk/government/publications/sti-quarterly-surveillance-reports-provisional-data/quarterly-report-on-diagnoses-of-syphilis-gonorrhoea-and-ceftriaxone-resistant-gonorrhoea-in-england-provisional-data-march-2025
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 September 2024
Main points
Diagnoses of infectious syphilis (primary, secondary and early latent stages) at sexual health services in England continue to decrease slightly in quarter 3 (July to September) 2024 to an estimated 2,290, down from 2,350 in the previous quarter. Diagnoses of syphilis appear to be levelling.
There were an estimated 17,980 diagnoses of gonorrhoea at sexual health services in England in quarter 3 2024, slightly higher than 17,820 in the previous quarter. This shows a slight increase after a downward trajectory since quarter 2 (April to June) 2023.
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 STI data.
Figure 1a. Provisional data on diagnoses of infectious syphilis [note 1] in England by quarter, January 2019 to September 2024
Figure 1b. Provisional data on diagnoses of gonorrhoea in England by quarter, January 2019 to September 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 20 March 2025
Main points
Ceftriaxone-resistant Neisseria gonorrhoeae (the bacterium that causes gonorrhoea) was first detected in England in 2015. By March 2025, a total of 42 cases had been reported in England, 15 of which were extensively drug-resistant (XDR, resistant to first- and second-line antibiotics) (Figure 2).
The frequency of detecting ceftriaxone-resistant Neisseria gonorrhoeae has increased with 33 cases, including 14 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 20 March 2025
Source: Referrals to the STIRL at 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.
Note 4: 2025 is showing provisional data from January to 20 March 2025.