Rising Gonorrhea Cases Prompt Urgent Public Health Warning

With this message we draw your attention to the continuous increase of gonorrhea (Neisseria (N.) gonorrhoeae).

Continuous increase in gonorrhea

There are more and more people from mid-2022 N. gonorrhoeaediseases. The increase among heterosexual young people with higher education under the age of 25 of Dutch origin is particularly striking (Signs Consultation mark 3825). An increase is also seen in Europe (Nerlander, Eurosurveillance, mark 3993).

Council

To test

The RIVM advises that heterosexual women and men should be tested for gonorrhea in an accessible way. Also people without complaints or high risk behaviour. Gonorrhea is easily transmitted genito-orally and genito-vaginally. Gonorrhea often appears without symptoms in women. If oral exposure occurs, the RIVM recommends that an additional pharyngeal swab be taken.

To deal with

The treatment of choice is single intramuscular ceftriaxone 500 mg. If the 500 mg dose is not available, it is recommended to take 1000 mg once. For other recommendations and other options for treatment, including resistant gonorrhea, see the NHG status, SOA MDR in Gonorrhea LCI guidelines.

Contact partners

Calling partners is essential. The RIVM is calling all health care providers pay extra attention to this. Through partnerwaarschuwing.nl it is possible to contact participants anonymously. For this, the client needs a code that is generated by the health care provider after a laboratory-confirmed diagnosis. To generate a code for a customer, the professional can already create an account. For partner caution you can also go to a Sexual Health Centre GGD are mentioned.

Report ceftriaxone resistance

Gonococci are resistant to all antibiotics used for treatment (Unemo 2019, CDC 2023). Multi-resistant gonococci occur worldwide (WHO 2023). To date, no ceftriaxone-sensitive strains have been found in the Dutch gonococcal survey (GRAS – Gonococcal Resistance to Antibiotic Surveillance). But it is very possible. For example, ten infections with ceftriaxone-resistant gonococci have been confirmed in the UK in the past year (Day 2022).

If complaints persist after ceftriaxone treatment, take a culture N. gonorrhoeae from This makes it possible to determine the protection pattern. And the client can be treated based on the culture, as well as advice from SOA MDR.

Report a ceftriaxone resistant culture N. gonorrhoeae urgently reference laboratory (GGD Amsterdam regional laboratory), via 020-5555275.

Disease course and complications
Gonorrhea is often asymptomatic in women. However, infection can lead to Pelvic Inflammatory Disease (PID) and, in the long term, to reduced fertility, for example. Men regularly get inflammation of the urethra (urethritis). The complaints (burning sensation, pain when sewing, pus-like discharge) usually occur within a few days after infection. Anorectal and pharyngeal infections are often asymptomatic (Unemo 2019). Conjunctivitis can also develop as a result of (auto)inoculation. This can lead to keratitis in which corneal perforation can occur, the latter was also evident in the current increase (Symptom consultation 3900 mark).

Pay attention to sex education and condom use
Last year, the RIVM organized a condom campaign together with GGDs to increase awareness of STDs and condom use. Condoms were distributed at events attended by this young target group. The RIVM and Soa Aids NL also recommend structured sexual education and STD prevention.

In terms of,
LCI STD RIVM Team