Multidrug‑resistant gonorrhoea: Alert for clinicians in NSW

NSW Health has reported increasing cases of multidrug‑resistant (MDR) and extensively drug‑resistant (XDR) gonorrhoea in the community, including locally acquired infections. GPs and clinicians are asked to review the latest guidance and share this information with all staff.

Key messages

Local transmission of MDR gonorrhoea is rising in NSW, particularly among heterosexual people, with some cases linked to contact with female sex workers.
In symptomatic patients, collect swabs for gonorrhoea culture and PCR prior to treatment.
A test of cure is required 2 weeks after treatment is completed.
Ensure sexual partners from the past 2 months are notified, tested and treated to reduce transmission.

Current situation

11 MDR cases have been diagnosed in NSW so far in 2026 (41 cases in 2025).
5 XDR cases have been identified since February 2025.
Increasing evidence of local transmission, including in people without travel history.

Clinical advice

For patients with symptoms or a positive PCR result:

Take a risk history, including travel and contact with sex workers.
Collect a culture swab before treatment, regardless of symptoms.
Screen for other STIs including chlamydia, syphilis, HIV and hepatitis B.

Recommended treatment

Anogenital gonorrhoea: IM ceftriaxone 500 mg (in 2 mL 1% lignocaine) + oral azithromycin 1 g stat.
Oropharyngeal gonorrhoea: IM ceftriaxone 500 mg (in 2 mL 1% lignocaine) + oral azithromycin 2 g stat.
Do not delay treatment while awaiting culture results.
For MDR/XDR notifications, seek advice from your local sexual health service or an infectious diseases physician.

For full clinical guidance, visit: https://sti.guidelines.org.au

Read the full NSW Health alert.