Gonorrhea guide: Etiology and epidemiology

On this page

• Etiology
• Epidemiology
• Surveillance of antimicrobial resistance in gonorrhea
• References

Etiology

N. gonorrhoeae is a Gram-negative diplococcus^{Footnote 1}. This highly infectious bacterium colonizes and infects genital mucosa and it may also infect extragenital sites, including the oropharyngeal, conjunctival and anorectal mucosae^{Footnote 2}.

N. gonorrhoeae can develop antimicrobial resistance (AMR) rapidly and has developed resistance to every class of antimicrobial used to treat it^{Footnote 3Footnote 4}; some of these antibiotics (sulphonamides, penicillins, tetracyclines) are ineffective and are no longer used.

Travel-related ceftriaxone-resistant gonorrhea isolates were reported in Canada in 2017^{Footnote 5} and 2018^{Footnote 6} and isolates with decreased susceptibility to cephalosporins (cefixime and ceftriaxone) continue to emerge. Resistance to azithromycin is increasing and treatment failures have been reported in Canada and around the world.

Epidemiology

Gonorrhea is the second most commonly reported STIs in Canada, with a gradual and steady increase in reported cases of gonorrhea since 1997. Gonorrhea may be undiagnosed or unreported because gonorrheal infections are often asymptomatic.

Between 2010—2015, gonorrhea rate was higher among males than among females. In addition, the rate increased at a faster pace in males than females. Adolescents and young adults (15-29 age group) are the most affected^{Footnote 8}.

More information

Local epidemiological information: Consult your public health unit.

National epidemiological information:

• Notifiable Diseases Online
• Canadian Communicable Disease report: Gonorrhea in Canada, 2010--2015^{Footnote 8}

Global epidemiological information:  

• World Health Organization Report on global sexually transmitted infection surveillance

Surveillance of antimicrobial resistance in gonorrhea

Antimicrobial-resistant N. gonorrhoeae is a global public health challenge^{Footnote 3}. Surveillance of AMR in N. gonorrhoeae is crucial to monitor trends and inform efforts to prevent and control its spread.

There is a growing shift in Canada towards the use of NAAT instead of culture to test for N. gonorrhoeae. As a result, fewer samples are available for susceptibility testing, making it difficult to generate an accurate picture of drug resistance^{Footnote 9}.

The national program, Enhanced Surveillance of Antimicrobial-Resistant Gonorrhea (ESAG) integrates epidemiologic and treatment failure data into existing laboratory-based monitoring of antimicrobial-resistant N. gonorrhoeae. ESAG information enables early identification of drug-resistant gonorrhea and assists in identifying appropriate and effective treatment, which helps prevent its spread.

In Canada, N. gonorrhoeae displays high rates of resistance to penicillin, tetracycline, erythromycin and ciprofloxacin^{Footnote 9}. These antimicrobial agents should only be used to treat gonococcal infections if susceptibility is confirmed.

There have been reports of resistance to azithromycin and decreased susceptibility to cephalosporins in Canada. Treatment failures have also been reported with the use of third generation oral^{Footnote 10Footnote 11} and injectable cephalosporins. Cases of gonorrhea with high-level resistance to both ceftriaxone and azithromycin have been reported in Canada, the United Kingdom, Australia and Hawaii^{Footnote 12Footnote 13Footnote 5}.

References