Antibiotic-Resistant Gonorrhea Cases Rise in Sweden, Sparking Public Health Concerns

Sweden is witnessing a concerning increase in antibiotic-resistant gonorrhea cases, with local transmission chains now established, marking a significant shift in the disease's epidemiology in the country. According to reports from the Public Health Agency of Sweden and the European Centre for Disease Prevention and Control (ECDC), the number of antibiotic-resistant gonorrhea cases rose to nine in 2022, with an additional four cases reported so far in 2023. This spike contrasts with previous years, where the maximum number of such cases was three annually, mostly linked to infections contracted abroad.

The resistant strains primarily show resistance to ceftriaxone, the current first-line treatment, and to some extent to azithromycin as well. This development raises concerns about potential treatment failures, although treatment with older antibiotics remains possible. Folkhälsomyndigheten (the Public Health Agency) has established a surveillance program to monitor this emerging threat but has not initiated immediate additional actions.

Gonorrhea, caused by Neisseria gonorrhoeae, remains the second most common sexually transmitted infection in Sweden, recording 4,268 cases in 2025 with an average annual increase of 8% in incidence per 100,000 inhabitants between 2016 and 2025. Despite this increase, the growth rate has moderated somewhat this year. Testing and treatment for gonorrhea continue to be offered free of charge in Sweden.

While new treatment options such as the antibiotic zoliflodacin have shown efficacy against resistant strains, this drug is not yet approved for use in the European Union, limiting immediate treatment alternatives.

Microbiologist Thomas Åkerlund from the Public Health Agency of Sweden described the situation as "alarming," emphasizing the importance of enhanced monitoring as a response to the threat posed by increasing antibiotic resistance in gonorrhea. The ECDC has urged EU countries, including Sweden, to strengthen their surveillance efforts to better understand and combat the spread of resistant gonorrhea bacteria.