Antimicrobial susceptibilities of Neisseria gonorrhoeae in Canada, 2022.

Background: In Canada, gonorrhea is the second most prevalent sexually transmitted bacterial infection. The Gonococcal Antimicrobial Surveillance Programme-Canada (GASP-Canada), a passive surveillance system monitoring antimicrobial resistance in Neisseria gonorrhoeae in Canada since 1985, is the source for this summary of demographics, antimicrobial resistance and N. gonorrhoeae multi-antigen sequence typing (NG-MAST) of gonococcal isolates collected in Canada in 2022.

Objective: To summarize the antimicrobial resistance trends and molecular types of N. gonorrhoeae cultures in Canada from 2018 to 2022. These trends inform the federal, provincial and territorial guidelines for treatment of gonorrhea.

Methods: Provincial and territorial public health laboratories submitted N. gonorrhoeae cultures and data to the National Microbiology Laboratory in Winnipeg as part of the surveillance system. The antimicrobial resistance and molecular type of each isolate received were determined.

Results: In total, 3,855 N. gonorrhoeae cultures were identified and tested across Canada in 2022, a 12.1% increase since 2021 (n=3,439). Decreased susceptibility to cefixime declined in 2022 (0.3%) compared to 2018 (0.5%). Decreased susceptibility to ceftriaxone also declined between 2018 (0.6%) and 2022 (0.3%). Azithromycin resistance was similar in 2022 (8.1%) to what it was in 2018 (7.6%). In 2022, NG-MAST-17972 (13.3%) was the most prevalent sequence type in Canada.

Conclusion: The spread of antimicrobial-resistant gonorrhea is a significant public health concern. The continued regional and national surveillance of antimicrobial resistance in N. gonorrhoeae is essential in ensuring effective treatment therapies are recommended.