Multi-drug resistant gonorrhea identified
April 4, 2023
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To: Local Health System Partners
FOR IMMEDIATE ATTENTION
Important information regarding ceftriaxone non-susceptible gonorrhea in Ontario
Recent international reports from Europe and USA have identified a multi-drug resistant strain of Neisseria gonorrhoeae. Through routine provincial disease surveillance activities, an Ontario patient with no known travel history was recently identified as having a gonorrhea infection with a similar resistance pattern. For instance, a reduced susceptibility to ceftriaxone and cefixime, as well as resistance to ciprofloxacin, penicillin, and tetracycline, which suggests circulation of this multi-drug resistant strain within Ontario.
In this context, and per the attached memo, the Ministry of Health is recommending:
- For all patients with suspected gonorrhea infection, collect swabs for N. gonorrhoeae culture as well as specimens for NAAT testing for N. gonorrhoeae from all potentially exposed sites (i.e. urethral/cervical, pharyngeal, rectal). It is recommended to collect both types of specimens for patients given that NAAT is more sensitive, and culture allows assessment for drug sensitivity. Swabs should be received within 48 hours if possible but will be accepted by Public Health Ontario Laboratory up to 72 hours after collection. For additional details on specimen collection and submission, please see the Public Health Ontario Test Information Index.
- As per the Canadian Guidelines on Sexually Transmitted Infections (CGSTI), test of cure is currently recommended for all positive cases of N. gonorrhoeae at all positive sites. Culture is the preferred method for test of cure and should be performed 3–7 days after completion of treatment. If culture is not available, test of cure by NAAT will also be accepted and should be performed at 2–3 weeks post- treatment.
Current CGSTI guidance advises to re-screen persons with gonorrhea infection at 6 months post-treatment or else at the first follow-up appointment within 12 months, given risks of re-infection due to ongoing or repeat exposure.
Health care practitioners are asked to call the Sexual Health Clinic at 705.522.9200, ext. 482 (toll-free 1.866.522.9200) to report a case with multi-drug resistant gonorrhea infection, or for additional information.
Original Signed By
Dr. Penny Sutcliffe
Medical Officer of Health and Chief Executive Officer
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This item was last modified on April 4, 2023