References UK clinical guidance from the NHS, the British HIV Association (BHIVA), and the British Association for Sexual Health and HIV (BASHH). Last updated: April 2026.
Gonorrhoea is one of the most concerning STIs because of rapidly rising antibiotic resistance. It has developed resistance to every class of antibiotic used against it over the past 80 years. Current first-line treatment is still effective for most people, but new drugs are being developed to stay ahead of the evolving bacterium.
Here’s where things stand.
Order a discreet home STI test
Current First-Line Treatment
- Ceftriaxone 1g intramuscular injection — the standard UK treatment since 2019
- Single dose, given in a sexual health clinic
- Test of cure recommended, especially for pharyngeal (throat) infection
The History of Gonorrhoea Resistance
| Drug | Era | Status |
|---|---|---|
| Sulfonamides | 1930s-1940s | Resistance emerged quickly |
| Penicillin | 1940s-1980s | Widespread resistance now |
| Tetracyclines | 1960s-1980s | Resistance common |
| Fluoroquinolones (ciprofloxacin) | 1980s-2000s | Resistance common |
| Oral cephalosporins | 2000s | Reduced susceptibility |
| Ceftriaxone (current) | 2010s-today | Still effective but resistance emerging |
Why Gonorrhoea Is Hard to Treat
- Naturally good at picking up resistance genes from other bacteria
- Can exchange resistance genes between strains
- Pharyngeal infection is particularly hard to clear
- High rates of reinfection allow more opportunities for resistance to spread
New Drugs in Development
- Zoliflodacin — a new oral antibiotic that showed promise in trials for uncomplicated gonorrhoea
- Gepotidacin — another novel oral antibiotic in development
- Combinations — using two drugs together to reduce resistance risk
- Extended-release formulations — longer-lasting single-dose options
The Global Response
The World Health Organisation (WHO) considers gonorrhoea a priority pathogen for antibiotic resistance. The response includes:
- Surveillance of resistance patterns
- Updated treatment guidelines as resistance evolves
- Research into new drugs and vaccines
- Public health campaigns for prevention and testing
Can a Vaccine Help?
There is currently no gonorrhoea vaccine, but research is ongoing. Interestingly, some studies have suggested that the meningitis B vaccine may offer partial protection against gonorrhoea — and some sexual health clinics are offering it to high-risk groups. More research is needed to confirm its role.
What You Can Do
- Complete prescribed treatment fully
- Attend follow-up and test of cure appointments
- Use condoms to reduce transmission
- Notify partners so they can be tested and treated
- Get regular STI screening
- Consider DoxyPEP if eligible (reduces other bacterial STIs)
Read more: What is gonorrhoea? | Gonorrhoea rapid tests | Best antibiotics for STIs
Frequently Asked Questions
Is gonorrhoea still curable?
Yes — current first-line treatment still works for most infections. Resistance is a concern but not yet a routine treatment failure issue.
What happens if treatment doesn’t work?
Test of cure catches treatment failure, and alternative antibiotics are used. Specialist input may be needed for resistant cases.
Will there be a vaccine?
Research is ongoing. Early evidence suggests meningitis B vaccine may offer partial protection. A dedicated gonorrhoea vaccine is a longer-term goal.
Related reading
- Comprehensive Test: Chlamydia, Gonorrhoea and Herpes
- Chlamydia and Gonorrhoea Lab Test
- Gonorrhoea Rapid Tests: What to Know
- Home Chlamydia and Gonorrhoea Tests: How They Work
- How Common Is Gonorrhoea in the UK?
Sources
- NHS — Sexual health conditions
- BASHH — UK clinical guidelines for STI management
- British HIV Association (BHIVA) — HIV treatment guidelines
- Terrence Higgins Trust — sexual health information
- UK Health Security Agency — STI surveillance data
Steve Page is a recognised expert on Sexually Transmitted Diseases (STDs) and STD treatments, having published numerous articles in peer-reviewed journals and presented his research at conferences around the world. He has an in-depth understanding of the latest medical research on STDs, and is an advocate for the development of new treatments and protocols to improve the health of those affected. In addition to his research, he has dedicated his career to understanding the causes and symptoms of STDs, as well as how to best treat those impacted.
