Gonorrhea has been developing resistance to every antibiotic used to treat it since sulfa drugs were introduced in the 1930s. Each successive first-line treatment — penicillin, tetracycline, fluoroquinolones, azithromycin — has been rendered clinically unreliable by the extraordinary adaptability of Neisseria gonorrhoeae, a bacterium that has served as a textbook example of antibiotic resistance evolution for three generations of infectious disease specialists. In 2026, the story has moved from textbook warning to clinical emergency.
The World Health Organization's 2026 Global Antimicrobial Resistance and Use Surveillance System (GLASS) report documented a sixfold global rise in gonorrhea resistance to azithromycin — one of the two antibiotics that until recently formed the CDC's recommended dual-therapy regimen. The data compound a trend that has been building since 2019, when WHO surveillance first began documenting azithromycin resistance in gonorrhea strains from South and Southeast Asia. Those resistant strains have been traveling internationally, seeding themselves in sexual networks in North America and Europe.
