Guidance

National gonorrhoea vaccination programme using 4CMenB vaccine: frequently asked questions

Published 29 May 2026

Why does the UK have a gonorrhoea vaccination programme? 

Gonorrhoea diagnoses in England are at record highs with over 70,000 cases reported in 2024. Around half of gonorrhoea diagnoses annually in England are in gay, bisexual or other men who have sex with men (GBMSM).  

Gonorrhoea can result in symptoms such as vaginal or urethral discharge, pain on urination and bleeding after sex or between periods, although many people with gonorrhoea have no symptoms. If left untreated, gonorrhoea can lead to pelvic inflammatory disease, infertility, ectopic pregnancy or long-term pain, painful infection of the testicles and, rarely, serious infection in the blood, skin or joints. Gonorrhoea can also increase the risk of acquiring other sexually transmitted infections, including HIV. The bacteria that causes gonorrhoea is classified as a high-priority pathogen by the World Health Organization due to widespread antimicrobial resistance. 

The UK’s national gonorrhoea vaccination programme using the 4CMenB (Bexsero)  vaccine started in August 2025 following advice from the Joint Committee on Vaccination and Immunisation (JCVI) to the Department of Health and Social Care (DHSC) and is still active. There is evidence of very rapid uptake among eligible GBMSM during the first few months of the programme (further details are in abstract O05 presented at the Joint Conference of the British HIV Association and British Association for Sexual Health and HIV).  

Which vaccine is being provided and in which setting? 

The national gonorrhoea vaccination programme uses the 4CMenB vaccine, a recombinant, protein-based vaccine which has been shown to provide high levels of protection against group B (MenB) invasive meningococcal disease. N. gonorrhoeae, the bacteria which causes gonorrhoea, and N. meningitidis, the bacteria which causes meningococcal disease, are genetically highly related. Several observational studies have reported a 33% to 47% reduction in gonorrhoea among people immunised with 4CMenB compared to those who were unvaccinated. Modelling suggested that even with this modest protection, the impact of a vaccination programme in groups at high risk of gonorrhoea could be substantial at a population-level.  

The 4CMenB vaccine is being provided to eligible people attending sexual health services in the UK. 

Who is eligible for vaccination? 

Around half of gonorrhoea diagnoses in England are in GBMSM.  This vaccination programme initially focuses on those GBMSM with markers of increased risk of gonorrhoea (multiple recent partners or a bacterial sexually transmitted infection (STI) history), but there is clinical discretion to offer the vaccine to other people at similarly high risk. Further details on eligibility are in the Gonorrhoea Green Book Chapter. 

Why have there been questions about the evidence base for the vaccination programme? 

After the presentation of the GoGoVax trial results at an international conference in February 2026, there have been concerns about the evidence base for the gonorrhoea vaccination programme in England. 

GoGoVax was a double-blind, randomised, placebo-controlled trial in Australia involving 587 gay and bisexual men who received either the 4CMenB vaccine or a placebo. The study team found no evidence of protection of the vaccine against gonorrhoea infection; people in both arms of the study had the same incidence of gonorrhoea (48 per 100 person-years) during the trial. The study results have not been published in a peer-reviewed scientific journal (as of 8 May 2026), but the study team presented their results at the CROI conference in February 2026 and they stated: 

It is possible that the high rates of gonorrhoea history among this particular study population make them less susceptible to any potential protective effects of vaccination.  

The results of this study cannot be generalised to other populations; however, they represent an important finding for gay and bisexual men at high risk.

The GoGoVax study team also published the results of the open-label MenGO trial in Australia which also found no evidence of protection, but this trial was conducted on a small sample of 130 gay and bisexual men and was only statistically powered to detect a 67% vaccine efficacy. Previously, the open-label DOXYVAC study in France also found no statistically significant evidence of protection but, like MenGO, lacked statistical power to detect the difference in gonorrhoea incidence observed between trial participants in each arm of the study. 

Unlike GoGoVax, both MenGO and DOXYVAC reported reductions in gonorrhoea incidence among gay and bisexual men vaccinated with 4CMenB.  

Do the trial results mean that the gonorrhoea vaccination programme has stopped? 

No, the gonorrhoea vaccination programme in the UK still continues given the need to reduce the incidence of gonorrhoea.  

In addition, there is a body of evidence from observational studies and modelling including economic evaluations that led to the JCVI’s advice.  

The UK Health Security Agency (UKHSA) is monitoring the impact and effectiveness of the gonorrhoea vaccination programme and plans to share these findings with the JCVI later in 2026 to 2027. As an independent expert advisory body to the UK government, the JCVI keeps all vaccination programmes under review. The JCVI will review real-world evidence from the current 4CMenB vaccination programme for the prevention of gonorrhoea when sufficient high-quality, robust data are available for analysis.

How might 4CMenB vaccine help reduce the incidence of gonorrhoea?  

N. gonorrhoeae, the bacteria which causes gonorrhoea, and N. meningitidis, the bacteria which causes meningococcal disease, are genetically highly related.  

Modelling of available evidence suggests that vaccinating GBMSM at increased risk of gonorrhoea, even with a vaccine with low efficacy, could have a large impact at a population level in the UK and is likely to be cost-saving – this informed JCVI’s advice for an opportunistic targeted gonorrhoea vaccination programme using the 4CMenB vaccine.  

To achieve this population-level impact, and to avoid rejecting this potentially important intervention, it is important that eligible people are offered the vaccine when they attend sexual health services.  

What is the evidence that 4CMenB vaccine protects against gonorrhoea? 

The strongest real-world evidence of protection against gonorrhoea is from South Australia where 2 doses of 4CMenB in adolescents is estimated to have a vaccine effectiveness of 46% for at least 4 years. A 2024 meta-analysis estimated a pooled vaccine effectiveness of 34% (95%CI, 27 to 41%) in case-control studies and 33% (95%CI, 9 to 56%) in cohort studies. While multiple studies have identified a protective effect of 4CMenB on gonorrhoea, these findings are based on observational evidence which is considered to be evidence of lower quality than randomised controlled trials. 

Why would the results of a randomised controlled trial assessing the efficacy of 4CMenB vaccination on gonorrhoea not match what we see in the real world? 

There are many reasons why a randomised controlled trial (RCT) may not reflect the impact of the gonorrhoea vaccination programme in the real world. These reasons include the fact that a vaccine with low efficacy may still provide population-level protection despite offering little individual protection (which is what RCTs, including GoGoVax, assess).  

Also, the participants of RCTs often vary demographically and behaviourally from the people who don’t participate in RCTs; this means that the findings of RCTs cannot always be generalised to the real world. 

The GoGoVax RCT found no evidence of protection of 4CMenB against gonorrhoea in GBMSM – most (90%) of the participants of this trial had gonorrhoea before entering the trial. The mechanism of protection of the vaccine is still unknown, but it may be the case that it offers less protection to people vaccinated at the same time as having a gonorrhoea infection, or who have had gonorrhoea prior to being vaccinated.  

UKHSA will monitor the impact and effectiveness of the gonorrhoea vaccination programme and share these findings with the JCVI who will, in turn, provide advice to the DHSC on the next steps for the programme. 

Vaccine programme evaluations are regularly conducted post-introduction of a new vaccine to bridge the gap between controlled clinical trials and real-world performance, ensuring that vaccination efforts are safe, effective, cost-efficient, and equitable.  

What should vaccinators at sexual health services tell eligible people when they are offering the vaccine? 

Informed verbal consent is required for all vaccinations, including 4CMenB for gonorrhoea prevention.  

As the 4CMenB vaccine is licensed for meningitis B, and is being used off-license for gonorrhoea, sexual health service staff should inform their clients that the vaccine is being used in accordance with national guidelines but outside the product licence. While the vaccine may offer relatively low individual protection against gonorrhoea, it could still reduce the overall incidence of gonorrhoea in the community. The vaccine is licensed and will offer direct protection against group B meningococcal disease (MenB).  

Sexual health staff should continue to provide advice on how to reduce the risk of gonorrhoea, for instance through condoms and regular STI testing.  

Further information on this vaccine for GBMSM attending sexual health services is provided in the guide to the Meningococcal B vaccine for protection against gonorrhoea. 

How will UKHSA assess the impact of the gonorrhoea vaccination programme? 

UKHSA will use its surveillance and research data to assess the uptake, impact and effectiveness of the gonorrhoea vaccination programme.  

Proposed analyses may include an interrupted time series analysis to assess the trend in gonorrhoea diagnoses after the launch of the vaccination programme, and a test-negative case-control analysis to assess the likelihood of being vaccinated among people diagnosed with and without gonorrhoea.  

Further details on these planned analyses are provided on GOV.UK.