Public Health Alert – Update on multi drug-resistant gonorrhea

An Ontario resident with no travel history was recently identified as having gonorrhea that was non-susceptible to ceftriaxone and cefixime, and resistant to ciprofloxacin, penicillin, and tetracycline. The individual is a male who reported sex with the opposite sex and one sexual contact. A multi drug resistant (MDR) strain of Neisseria gonorrhoeae may be circulating in Ontario. Drug resistance can be found using culture, as a nucleic acid amplification test (NAAT) does not identify drug susceptibility and resistance.

Actions requested

Testing

• At a minimum, test using N. gonorrhoeae culture plus NAAT for:
  • Symptomatic patients, when antimicrobial resistance is suspected
  • Test of cure
  • Pelvic inflammatory disease
  • Pregnancy
  • Sexual abuse or sexual assault
• Continue to test all exposed sites by collecting specimens for NAAT.
• Lifelabs can perform gonorrhea NAAT and culture testing using urine, endocervical, vaginal, rectal and pharyngeal samples, and all positive cultures are automatically sent by Lifelabs to PHOL for antimicrobial susceptibility.
• Test information Lifelabs culture, Lifelabs swab, and Lifelabs urine samples.

Treatment failure

Treatment failure is defined as absence of reported sexual contact during post-treatment period AND one of:

• Gram-negative diplococci on microscopy in penile urethral swabs taken at least 72 hours after treatment completion
• Positive N. gonorrhoeae on culture taken at least 72 hours after treatment completion.
• Positive N. gonorrhoeae NAAT taken at least 2-3 weeks post-treatment.

In the event of cephalosporin treatment failure, consultation with an infectious disease specialist is recommended.

Prevention and reporting

• Repeat gonorrhea screening is recommended six months post-treatment for all cases
• Counselling on all STBBIs, prevention and risk is recommended; consider offering testing for other STBBIs.
  • Instruct individuals to abstain from sex for seven days after they and their sexual partner(s) have completed treatment and symptoms have resolved
• Consider vaccination for hepatitis A, hepatitis B, human papillomavirus (HPV) and MPOX for those eligible and at risk. Northwestern Health Unit (NWHU) can assist, if needed.
• Report all cases of gonorrhea to NWHU, including as much information as possible about how to reach the patient and any information the patient shared about sexual partners.

For further information please see the Public Health Alert from Public Health Ontario.

Contact:
Dr Kit Young Hoon
Medical Officer of Health
Northwestern Health Unit