Drug-resistant gonorrhoea is increasingly spreading within Sweden, with health authorities detecting more cases and signs that transmission is increasingly taking place within the country rather than being associated mainly with infections acquired abroad. Sweden recorded nine cases in 2025, compared with no more than three a year between 2020 and 2024, while another four cases have been identified so far in 2026.
The resistant strain is of particular concern because ceftriaxone is the main antibiotic currently used to treat gonorrhoea. Thomas Åkerlund, a microbiologist at the Swedish Public Health Agency (Folkhälsomyndigheten), told Swedish news agency TT that many of the recent infections now appear to have been acquired within Sweden, something that had previously been unusual.
Resistant gonorrhoea is increasingly transmitted within Sweden
The increase remains small in absolute numbers, but it marks a change in the epidemiological pattern. According to Folkhälsomyndigheten’s annual data, Sweden reported nine cases involving ceftriaxone-resistant Neisseria gonorrhoeae in 2025. Between 2020 and 2024, between zero and three such cases had been recorded each year.
Previously, most resistant infections detected in Sweden were isolated cases linked to travel abroad. In 2025, however, health authorities found several indications of transmission taking place within Sweden itself.
Six of the resistant bacterial isolates analysed by the national reference laboratory in 2025 were resistant not only to ceftriaxone but also to cefixime and azithromycin, two other antibiotics that have been used against gonorrhoea.
The development comes as gonorrhoea remains relatively widespread in Sweden. 4,268 cases were reported in 2025, slightly fewer than the 4,365 recorded in 2024. About 73 percent of infections reported in 2025 were believed to have been acquired within Sweden.
Ceftriaxone resistance is also increasing across Europe
Sweden is not an isolated case. The European Centre for Disease Prevention and Control warned in July that ceftriaxone-resistant gonorrhoea is becoming more common across Europe, with increasing evidence of domestic transmission.
Since 2022, resistant strains have been detected in several European countries. According to the ECDC, infections were initially mostly sporadic and often associated with international travel, but the pattern changed during 2025 and 2026, when several countries began reporting growing numbers and local transmission.
The agency currently considers the risk to the general population low, but warns that the establishment of highly resistant strains could progressively reduce available treatment options.
Treatment options still remain available
Ceftriaxone remains the standard first-line treatment for gonorrhoea in Europe, which makes resistance to the antibiotic particularly relevant for public health authorities.
However, resistant gonorrhoea can still be treated in Sweden. Åkerlund told TT that an older antibiotic remains available for infections resistant to ceftriaxone. He also said that a new antibiotic currently approaching use could offer another treatment option, although its effectiveness against these strains still needs to be established.
The situation therefore does not mean that gonorrhoea has become untreatable. The concern is instead that Neisseria gonorrhoeae has repeatedly developed resistance to antibiotics used against it, progressively narrowing the range of reliable treatments.
The ECDC has called for stronger antimicrobial-resistance surveillance, susceptibility testing and rapid identification and treatment of infections. For Sweden, the emergence of domestic transmission means that monitoring resistant strains will increasingly depend not only on identifying infections acquired abroad, but also on detecting transmission chains already established within the country.
