Multidrug-Resistant Gonorrhoea on the Rise in Sydney, NSW Health Says

Sydney - Health authorities in New South Wales have issued an urgent alert to clinicians following a rise in local transmission of multidrug-resistant (MDR) gonorrhoea, particularly among heterosexual populations and individuals with links to sex workers.

The NSW Ministry of Health reported on Monday that 11 cases of MDR gonorrhoea have already been diagnosed in the first weeks of 2026, building on a total of 41 cases recorded throughout 2025.

Of particular concern to officials is the identification of five extensively drug-resistant (XDR) cases since February last year, signaling a sophisticated level of resistance to standard antibiotic treatments.

Dr. Vicky Sheppeard, Acting Executive Director of Health Protection NSW, stressed the shifting demographics of the outbreak in a formal advisory to the state’s medical community.

"Local transmission of multidrug resistant gonorrhoea is increasing in NSW in heterosexual people, including recent cases with links to female sex workers," Sheppeard said.

The clinical guidance issued by the Ministry urges healthcare providers to adopt rigorous diagnostic protocols to stay ahead of the resistant strains.

The department has mandated that in all symptomatic patients, doctors must collect swabs for both culture and Polymerase Chain Reaction (PCR) testing prior to the commencement of treatment.

The dual approach is intended to ensure that the specific resistance profile of each infection is captured, even as immediate treatment begins, NSW Health said.

The standard recommended intervention for anogenital infection remains a combination of intramuscular ceftriaxone and oral azithromycin.

Health officials however warned that the efficacy of these frontline drugs is under threat.

"Correct treatment of gonorrhoea prevents the emergence of MDR and XDR strains," the Ministry advisory noted, adding that "if you receive a notification of MDR or XDR gonorrhoea, contact your local sexual health service or infectious diseases physician for treatment advice."

In addition to pharmacological treatment, the state is prioritizing a robust test of cure protocol, the advisory said, with patients being instructed to undergo follow-up PCR testing at each site of infection two weeks after completing their medication.

To prevent further community spread, the health department is also placing a high burden of responsibility on treating clinicians to oversee comprehensive contact tracing.

"Contact tracing is essential for all people with gonorrhoea to reduce transmission and prevent re-infection," the department’s communique said, adding that "all sexual partners should be traced back for a minimum of two months."

The surge in resistant cases in New South Wales mirrors a global trend of super-gonorrhoea that has challenged public health systems in several jurisdictions.

NSW Health advised that patients must abstain from sexual contact for seven days after beginning treatment, or until symptoms have fully resolved, to ensure the cycle of transmission is broken.