NEWS - Multidrug resistant (MDR) gonorrhea in Ontario - April 2023
As per a memo from the Chief Medical Officer of Health, a recent Ontario case suggests circulation of a multi-drug resistant strain of N. gonorrhoeae within the province. Please review the Chief Medical Officer of Health’s Memo which includes a recommendation for both swabs for N. gonorrhoeae culture as well as specimens for NAAT testing for N. gonorrhoeae from all potentially exposed sites (e.g., urethral/cervical, pharyngeal, anorectal) for suspect cases. The memo also contains additional background information.
Sexual Health team staff are also available to discuss case management and to support notification and follow-up of contacts by calling 807-625-5976.
Reporting Obligations
Individuals with suspect or confirmed cases must be reported to the Thunder Bay District Health Unit by the next working day by fax, phone or mail.
- Fax: (807) 625-4866
- Phone: 625-5976 or toll-free at 1-888-294-6630, ext. 5976
- Mail: 999 Balmoral Street, Thunder Bay, ON P7B 6E7
Epidemiology
Aetiologic Agent:
The causative agent for gonorrhea is a gram-negative diplococcus, Neisseria gonorrhoeae.
Clinical Presentation:
Many cases are asymptomatic. Presentation and severity differs in males and females. In males, the most common presenting symptom is a painful, purulent urethral discharge usually with dysuria and increased frequency of urination as well as redness, itching and urethral swelling.
Females present with initial urethritis, Bartholinitis, or cervicitis which is frequently mild and can go unnoticed. Abnormal vaginal discharge and post-coital bleeding may occur and infection can progress to pelvic inflammatory disease.
Pharyngeal and anorectal gonorrhea infections are more likely to be asymptomatic and can occur in those that are engaging in oral and anal sex.
Complications and sequelae: Pelvic Inflammatory Disease (PID), infertility, ectopic pregnancy, chronic pelvic ain, reactive arthritis, disseminated gonococcal infection, and epididymo-orchitis.
Modes of transmission:
Sexual contact via oral, vaginal, cervical, urethral or anal routes. In children, transmission can occur if exposed to infected genitals (consider the possibility of sexual abuse).
Newborns can be infected during delivery from an infected woman.
Incubation Period:
In individuals who display symptoms, the incubation period is usually 2-7 days.
Period of Communicability:
Can extend for months if untreated. Effective treatment usually ends communicability within hours.
Risk Factors/Susceptibility
Transmission is more effective male to female than female to male. Risk factors include:
- Individuals who have had sexual contact with a person with a confirmed or suspected gonococcal infection
- Sexually active youth < 25 years of age
- Individuals who have had sex with multiple partners
- Men who have unprotected sex with men
- Vulnerable populations (e.g., sex trade workers, street-involved youth, etc.)
- Individuals with a history of other sexually transmitted infections, including HIV.
Diagnosis & Laboratory Testing
Neisseria gonorrhoeae is confirmed when detected in an appropriate clinical specimen (e.g., urogenital, rectal or throat (pharyngeal) swab, urine).
APRIL 2023 – Recommendations from the Chief Medical Officer of Health due to a recent Ontario case suggesting circulation of a multi-drug resistant strain of N. gonorrhoeae:
- Collect swabs for N. gonorrhoeae culture as well as specimens for NAAT testing for N. gonorrhoeae from all potentially exposed sites (e.g., urethral/cervical, pharyngeal, rectal) for all patients with suspected gonorrhea infection. 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.
For any questions related to testing, please contact Public Health Ontario’s Customer Service Centre by phone: 416-235-6556 or 1-877-604-4567 (Toll Free) or by email: customerservicecentre@oahpp.ca.
See Additional Resources (links below) and the Summary of Recommendations: Ontario Gonorrhea Testing and Treatment Guide, 2nd Edition, 2018. (PDF)
Testing Information & Requisition
Treatment & Case Management
Treatment is under the direction of the attending health care provider.
Provide education about and promote safer sex practices.
Regardless of test results, sex partners are recommended to receive empiric treatment as per the treatment recommendations as soon as possible.
APRIL 2023 – Recommendations from the Chief Medical Officer of Health due to a recent Ontario case suggesting circulation of a multi-drug resistant strain of N. gonorrhoeae:
- Test of cure is currently recommended for ALL positive cases of N. gonorrhoeae at all positive sites as per the Canadian Guidelines on Sexually Transmitted Infections (CGSTI). 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.
Contact your local Public Health Unit regarding case management and to support notification and follow up of contacts for any patients with multi-drug resistant gonorrhea infection.
For any questions related to testing, please contact Public Health Ontario’s Customer Service Centre by phone: 416-235-6556 or 1-877-604-4567 (Toll Free) or by email: customerservicecentre@oahpp.ca.
See Additional Resources (links below) and the Summary of Recommendations: Ontario Gonorrhea Testing and Treatment Guide, 2nd Edition, 2018. (PDF)
Patient Information
References
Additional Resources
Public Health Ontario. (2019). Bacterial STI Testing: Quick Reference. (PDF)
Public Health Ontario. (2019). Gonorrhea Treatment Quick Reference. (PDF)
Heymann, D.L. Control of Communicable Disease Manual (21st Ed.). Washington, American Public Health Association, 2022.