Quarterly report on diagnoses of syphilis, gonorrhoea and ceftriaxone-resistant gonorrhoea in England: provisional data, June 2025
Updated 3 June 2025
Applies to England
© Crown copyright 2025
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Diagnoses of syphilis and gonorrhoea from January 2019 to December 2024
For the June 2025 quarterly report, the number of diagnoses of syphilis and gonorrhoea from January 2019 to December 2024 are not provisional data. They use the complete data set up to the end of 2024, consistent with the annual STI official statistics published on 3 June 2025, which include more detailed information on all sexually transmitted infections (STIs).
Main points
Diagnoses of infectious syphilis (primary, secondary and early latent stages) at sexual health services in England decreased slightly in quarter 4 (October to December) 2024 to an estimated 2,320, down from 2,440 in the previous quarter. However, the overall trajectory during 2024 was a continued increase in diagnoses of syphilis with the annual total rising from 2023 (9,375) to 2024 (9,535).
There were an estimated 17,700 diagnoses of gonorrhoea at sexual health services in England in quarter 4 (October to December) 2024, slightly lower than 18,105 in the previous quarter. This shows a slight decrease from the previous quarter, but figures for the second half of 2024 had levelled compared with the preceding marked downward trajectory since quarter 2 (April to June) 2023. While the total annual number of gonorrhoea diagnoses has decreased from 85,370 in 2023 to 71,802 in 2024, these numbers remain relatively high overall.
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 data on diagnoses of infectious syphilis and gonorrhoea in England. These quarterly figures can be used to monitor indicative trends in the data. The 4 quarters for each year presented in this report correspond to the data by year presented in the annual STI official statistics and the indicators on the Sexual and Reproductive Health Profiles 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. Diagnoses of infectious syphilis [note 1] in England by quarter, January 2019 to December 2024
Figure 1b. Diagnoses of gonorrhoea in England by quarter, January 2019 to December 2024
Source: GUMCAD STI Surveillance System.
Note 1: infectious syphilis refers to primary, secondary and early latent stages.
All diagnoses of ceftriaxone-resistant Neisseria gonorrhoeae to 19 May 2025
Main points
Ceftriaxone-resistant Neisseria gonorrhoeae (the bacterium that causes gonorrhoea) was first detected in England in 2015. By May 19 2025, a total of 52 cases had been reported in England, 18 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 43 cases, including 17 XDR cases, being detected since the start of 2022. Furthermore, there have now been 14 cases reported in the first 5 months of 2025 which is greater than the number of cases reported for the entirety of 2024. Since the publication of the previous quarterly report a further 10 cases have been detected, with the majority of these being in April and May.
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 19 May 2025
Source: Referrals to the STIRL at UKHSA from sexual health services in England.
Note 2: extensively drug-resistant (XDR) infections are defined as resistant to both first- and second-line treatment options and to other antibiotics.
Note 3: 2025 is showing provisional data from January to 19 May 2025.