Decline in Decreased Cephalosporin Susceptibility and Increase in Azithromycin Resistance in Neisseria gonorrhoeae, Canada

Gonorrhea, caused by Neisseria gonorrhoeae, is the second most commonly reported sexually transmitted infection in Canada; ≈13,000 cases occur yearly, and rates have increased from 20.1 cases/100,000 population in 2000 to 39.2 cases/100,000 in 2013 (1). The infection is also a global public health threat, with ≈106 million cases/year occurring worldwide (2). Gonococci have acquired resistance to many antimicrobial agents used for treatment (3), however, which makes it imperative to conduct surveillance programs so appropriate treatment recommendations can be determined. In 2011, the increases in MICs of cephalosporins prompted the authors of the Canadian Sexually Transmitted Infections Guidelines to update the recommended gonorrhea treatment from a single antimicrobial drug to combination therapy with ceftriaxone (250 mg intramuscularly) and azithromycin (1 g orally in a single dose) as the first-line treatment for uncomplicated anogenital and pharyngeal N. gonorrhoeae infections in adults (4). We analyzed antimicrobial drug susceptibility levels of N. gonorrhoeae to cephalosporins and azithromycin in Canada since the recommended treatments were updated in 2011.