Background

Gonorrhoea continues to represent a substantial global public health challenge, with an estimated 82.4 million new infections among adults in 2020. Although often treatable, Neisseria gonorrhoeae infection can lead to serious sequelae when untreated, including pelvic inflammatory disease, infertility, adverse pregnancy outcomes, and enhanced susceptibility to HIV acquisition.

The trajectory of antimicrobial resistance (AMR) in N. gonorrhoeae has fundamentally altered the treatment landscape. As resistance to extended-spectrum cephalosporins becomes increasingly documented across regions, the margin of therapeutic reliability continues to narrow, placing additional pressure on clinical decision-making and national treatment policies.

WHO is currently updating its treatment guidance to consider two novel oral agents, zoliflodacin and gepotidacin, for uncomplicated urogenital gonorrhoea. These agents raise new clinical and programmatic considerations, particularly in settings where injectable regimens pose operational constraints. This update will also inform WHO’s planned consolidation of its STI guidelines in 2027, which will include a comprehensive review of gonorrhoea treatment options and their optimal use across diverse epidemiological and programmatic contexts.

At the same time, STI surveillance systems in many countries remain fragmented, with variable integration across laboratory, clinical, and programme data sources. While the WHO Enhanced Gonococcal Antimicrobial Surveillance Programme (EGASP) provides a structured sentinel platform for gonococcal AMR monitoring, it represents only one component of broader STI surveillance architecture. In many settings, surveillance systems for STIs more broadly are not sufficiently linked to treatment policy processes or routine programme decision-making.

These gaps limit countries’ ability to translate surveillance data into timely, evidence-based public health decisions, including decisions on treatment policy, programme priorities and the response to emerging antimicrobial resistance.

Purpose of the Meeting

This closed workshop will provide a focused technical exchange on two connected priorities: updated WHO recommendations and emerging oral treatment options for gonorrhoea; and approaches to strengthen STI surveillance systems and the use of surveillance data in public health decision-making.

Objectives

• Exchange views on national treatment practices and country perspectives on new oral treatment options for gonorrhoea.
• Explore approaches to strengthen STI surveillance systems more broadly, and improve the use of surveillance data (including EGASP where relevant) for decision-making.

Expected Outcomes

• Shared understanding of gonorrhoea treatment options and the clinical, programmatic and surveillance considerations associated with their use.
• Identification of priority gaps and practical entry points for strengthening national STI surveillance systems, including the integration of laboratory, clinical and programme data and their use in decision-making.
• Identification of practical ways to strengthen the link between STI surveillance data, treatment-policy review and routine public health decision-making.

AGENDA

16:30–17:45
Session I: New options for gonorrhoea treatment

Moderator: Fuad Mirzayev, Team lead, WHO

Updated WHO 2026 treatment recommendations and emerging oral options: rationale and key considerations (10’)
Dr Fuad Mirzayev, Team lead, WHO

Surveillance for new treatment options (5’)

Prof. Magnus Unemo, Director, WHO CC for Gonorrhoea and Other STIs

Country presentations (20’)

Scope:
What is the current national treatment approach for gonorrhoea? How ready is the country to consider new oral agents, including potential use cases, surveillance requirements and susceptibility-testing needs?

Presenters: Dr Lon Sayheng, Cambodia; Mrs Gugu Shabangu, South Africa; Dr Rossaphorn Kittiyaowamarn, Thailand; Dr Nguyen Thi Thuy Van, Viet Nam
Q&A (40’)
All participants

17:45–18:15
Coffee break

18:15-19:30
Session II: Strengthening STI Surveillance
Moderator: Charalampos (Babis) Sismanidis, Team lead, WHO

Framing the case for stronger STI surveillance: overview of the white paper (10’)
Charalampos (Babis) Sismanidis, Team lead, WHO

Leveraging EGASP to strengthen national STI surveillance systems (5’)
Prof. Magnus Unemo, Director, WHO Collaborating Centre for Gonorrhoea and Other STIs

Country experiences: current landscape of STI surveillance and key systemic gaps (20’)

Presenters: Dr Kaoeun Chetra, Cambodia; Ms Venessa Maseko, South Africa;
Ms. Soracha Saengbanjerdkul, Thailand; Dr Nguyen Thi Thuy Van, Viet Nam

Facilitated discussion (40’)

Guiding questions:
- What are the most important challenges and opportunities for strengthening national STI surveillance systems?
- How can surveillance data be used more consistently in programme and treatment-policy decisions?
- Where would interoperability and integration across STI surveillance platforms add the greatest value?
- What financing and capacity-development priorities are needed to sustain improvements?