Antimicrobial resistance in gonorrhea: the influence of epidemiologic and laboratory surveillance data on treatment guidelines: Alberta, Canada 2001-2007.

OBJECTIVES

To describe the impact of surveillance for antimicrobial resistance (AMR) in Neisseria gonorrhoeae over a 7-year period on treatment guidelines in Alberta, Canada.

METHODS

AMR testing data from gonorrhea cases were combined with demographic and risk behavior information collected through surveillance to describe trends and sequential changes to treatment guidelines.

RESULTS

Ciprofloxacin resistant gonorrhea (CRG) cultures rose from 1.4% in 2001 to 27.7% in 2007. Of 200 CRG cases, 90% were men, 77% white, median age 29 years (interquartile range: 23-29 years) and 60% were men who have sex with men (MSM). In 2005, only 1 of 28 cases did not fit into travel or MSM categories and treatment guidelines were changed to recommend oral cefixime as the preferred agent in MSM or those with a travel history. Continuous rise in CRG together with locally acquired cases among heterosexuals resulted in ciprofloxacin being removed as a recommended agent for gonorrhea in 2007.

CONCLUSIONS

Our data underscores the importance of surveillance in monitoring trends in AMR in gonorrhea so that timely changes to treatment recommendations can be made in response to changing epidemiology.