Public Health Alert – MDR Neisseria gonorrhoeae

Situation

Internationally, there have been reports of multi-drug resistant (MDR) gonorrhea, and there has been an Ontario case of MDR gonorrhea identified in a patient with no known travel history. This strain of Neisseria gonorrhoeae has reduced susceptibility to ceftriaxone and cefixime and resistance to ciprofloxacin, penicillin, and tetracycline.

Goal

To detect the presence of MDR gonorrhea in Ontario.

Actions requested

• Continue to collect specimens for NAAT testing from all exposed sites
• When possible, additionally collect swabs for culture; the CMOH of Ontario recommends a swab for culture as well as NAAT testing from all potentially exposed sites (see memo)
  • Only swabs for culture can identify if the MDR strain of gonorrhea is present.
  • Swabs for culture must be received by the Public Health Ontario Laboratory no later than 72 hours after collection; consider local sample shipping limitations when sending swabs for culture. Samples may need to be collected Monday through Wednesday unless your facility has same-day shipping and/or shipping on the weekend to PHOL.
• In cases where exposure took place while traveling outside of our area, strongly consider swab for culture if the sample can be transported to PHOL within <72 hours.
• Canadian Guidelines on Sexually Transmitted Infections currently recommends test of cure for all positive cases of gonorrhea at all positive sites; this is preferably done by culture but if not available, can be NAAT performed 2-3 weeks post-treatment.
• Testing information can be found at Public Health Ontario Test Information Index.
• All cases of gonorrhea must be reported to NWHU and if you become aware of a patient with multi-drug resistant gonorrhea, please alert NWHU to support follow-up of the case and contacts. See Reporting diseases of public health significance for guidance on reporting.

For further information please see the memorandum from Dr. Kieran Moore, CMOH Ontario.

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