Skip to main content
STI & HIV 2023 World Congress Main banner
Final Program


Icon Legend
Back

Epidemiology & Monitoring

Category: Gonorrhoea - general

(P96) Disseminated Neisseria gonorrhoeae cases in Canada, 2016-2021

Tuesday, July 25, 2023
16:00 – 18:00 CST


Background:

Untreated cases of gonorrhea can enter the blood and other sterile sites and cause disseminated gonococcal infections (DGI). DGI cases can present as arthritis, dermatitis, migratory polyarthralgia, tenosynovitis, and in rare cases, endocarditis. Between 2016 and 2021 Minimum inhibitory concentrations (MIC) and molecular sequence types were determined, and whole genome sequencing (WGS) was performed for Neisseria gonorrhoeae DGI cultures across Canada to look for trends across the cases. The sources of isolation for DGI cultures included blood, eye, synovial fluid, peritoneal fluid, and cerebral spinal fluid.





Methods:

Between 2016 and 2021, N. gonorrhoeae strains isolated from DGI cases by Canadian provincial public health laboratories were submitted to the National Microbiology Laboratory Branch (NML) (N=224) for MIC determination by agar dilution as described by the CLSI, and N. gonorrhoeae multi-antigen sequence typing (NG-MAST). WGS was performed on all of these strains.





Results:

DGI cases submitted to the NML have increased steadily across the country, 224 DGI cultures were submitted between 2016 and 2021 (2016, n=5; 2017, n=26; 2018, n=32; 2019, n=57; 2020, n=55; 2021, n=49). The submitted DGI cases accounted for 0.2% of cultures submitted in 2016, 0.5% in 2017, 0.6% in 2018, 1.2% in 2019, 1.8% in 2020, and 1.4% in 2021. MICs for those cultures showed that 84.8% were resistant to one or more of ciprofloxacin, erythromycin, penicillin, and/or tetracycline; and 3.6% were resistant/had decreased susceptibility to azithromycin, cefixime or ceftriaxone. Three NG-MAST sequence types accounted for 62.5% of all cases. ST-11508 made up 29% (65/224) of cases in Canada, while 17% (38/224) of cases were ST-3671, and 16.5% (37/224) were ST-14994. Eight NG-MAST sequence types (ST-11508, ST-3671, ST-16211, ST-16286, ST-18355, ST-18774, ST-19804, and ST-19883) all contained porB-2206 (114/224, 50.9%), which is a persistent porB protein structure type “A” allele.





Conclusions:

The number of DGI cases nationally is trending up across Canada. This is of concern due to the severe morbidity that can be associated with some of these cases. Continued surveillance of antimicrobial susceptibilities and sequence types of N. gonorrhoeae is necessary to identify clusters, inform treatment guidelines and mitigate the impact of antimicrobial resistant gonorrhea.