Antimicrobial Resistance in N. Gonorrhoeae - Infographic

What you need to know:

• There has been an increase in reported cases of gonococcal infections in Canada since 1997.
• Gonococcal infections have shown progressive resistance to first-line
  antibiotic therapy, emerging as a public health threat worldwide.
• Treatment failures have been observed in Canada, particularly among men who have sex with men (MSM).
• Significant gaps exist in data about antimicrobial resistant N. gonorrhoeae strains, due to the increased use of Nucleic Acid Amplification Testing (NAAT) instead of culture for diagnosis.

What can you do?

Diagnose using culture:

Consider collecting samples for both cultures and NAAT.
Culture is particularly important:

• for symptomatic MSM;
• when pelvic inflammatory disease is suspected;
• when treatment failure is suspected or more likely to occur;
• or if the infection was acquired in a geographical area with high rates of antimicrobial resistance.

To help prevent resistance:

• Patients should be treated with combination therapy (i.e., two antibiotics with different modes of action).
• Monotherapy should be avoided.

Preferred therapy:

• For uncomplicated anogenital and pharyngeal infections is ceftriaxone 250mg IM PLUS azithromycin 1 gram PO.
• For uncomplicated anogenital infection in non-MSM adults only, cefixime 800mg PO PLUS azithromycin 1 gram PO may also be used.

Conduct follow-ups:

Test of cure should be done following completion of therapy:

• 3-7 days later using culture
  OR if culture unavailable,
• 2-3 weeks later using NAAT.

Report treatment failures:

• Cases of gonorrhea are reportable to public health officials. Treatment failures should also be reported.

For more details refer to the Canadian STI Guidelines Gonococcal Infections 2013 Revised Chapter.