Malawi is facing a critical public health threat as a strain of antimicrobial-resistant (AMR) gonorrhoea has been confirmed, leading to ineffective treatments and soaring resource costs across the health system.
Patients are increasingly returning to hospitals with symptoms even after completing prescribed medication with their partners, a clear sign that the Neisseria gonorrhoeae bacteria which causes the disease is evolving past conventional antibiotics.
Director of the HIV, STI, and Viral Hepatitis Department in the Ministry of Health Linly Chiwere confirmed the development, noting that AMR is a major threat to control programmes worldwide.
“The emergence of antimicrobial resistance among microorganisms that cause STIs is a major threat to control programmes worldwide,” Chiwere stated.
“One bacterium that is increasingly showing resistance to conventional antibiotics is neisseria gonorrhoea, which causes urethral discharge in men and pelvic inflammatory disease in women,” she said.
Chiwere added that the ministry has established an Antimicrobial Resistance Monitoring Unit to strengthen surveillance and provide updated treatment guidelines for resistant cases.
“We, in collaboration with stakeholders, are also strengthening social and behaviour change communication strategies on STI prevention and condom use, using innovative approaches such as social media and digital platforms,” she said.
Statistics from the Blantyre District Health Office (DHO), for example, show a rise in sexually transmitted infections (STIs) in recent months, many reported by the same patients, suggesting growing signs of drug resistance.
Figures show the district recorded 40 000 STI cases in 2024 and by June 2025, more than half of similar cases were reported.
To be more specific, between April and June, the office recorded 5 020 varied STI cases.
Of the registered cases, 1 355 returned to seek same medical attention, common on the list being gonorrhoea and partially syphilis.
The majority of these cases returned even after being treated together with their partners, signalling signs of drug resistance.
Kamuzu University of Health Sciences (Kuhes) sexual and reproductive health lecturer, who is also senior medical officer at the Blantyre DHO, Dr. Zaziwe Gunda said investigations show there is a surge in patients seeking STI treatment lately.
“In the second quarter of this year, we have seen a 50 per cent increase in STIs, most of them reported by individuals who came more than once. From the reported cases, we suspect that many STIs have developed resistance.
“Cases of discharge in both men and women are prevalent, standing at about 27 per cent. Patients receive treatment, but return with similar symptoms. These infections, sometimes asymptomatic, can cause serious health complications, including permanent reproductive damage,” he said.
Gunda added that the recurring infections are draining public health resources.
“These infections are costing taxpayers a lot as health facilities repeatedly treat the same conditions. I know of cases that have resulted in infertility. It is a serious problem that requires collective action.
“At Kuhes, we plan to conduct culture and sensitivity tests to identify real causes and determine whether we should change the antibiotics currently used to treat such STIs. This could help save the drug budget,” he added.
Meanwhile, national data shows a consistent increase in STI cases over recent years.
The Ministry of Health recorded 546 543 cases in 2024 up from 501 038 in 2023, 445 348 in 2022 and 385 699 in 2021.
In 2024, about 111 789 patients returned to seek similar treatment in less than a month
Officials believe the true figures may be higher, as many cases from private hospitals go unreported.
A July 2025 study published by the Africa Centres for Disease Control and Prevention said there is a rising spread of drug resistance across 14 African countries.
The report urged governments to strengthen laboratory testing, data systems and national health planning to combat hard-to-treat infections.
It also found that resistance to third-generation cephalosporins, a powerful group of antibiotics, was particularly high in Ghana and Malawi.
Meanwhile, health rights activist Maziko Matemba said the development demands urgent investigation by the Pharmacy and Medicines Regulatory Authority and other relevant institutions.
He said the public deserves to know about the findings, as access to effective medicines is crucial for patient well-being and public health, adding that they are monitoring the situation.
Malawi Health Equity Network executive director George Jobe described the trend as alarming.
“We are deeply concerned about the emerging threat of drug-resistant STIs, particularly neisseria gonorrhoea, which is increasingly showing resistance to conventional antibiotics.
“This poses a serious public health risk and adds financial strain on the health system because treating resistant infections requires longer, more expensive treatment,” he said.
Gonorrhoea remains one of the most common sexually transmitted infections globally, with over 80 million cases reported each year.
