Background While there is evidence that gonococcal antimicrobial resistance (GC AMR) is increasing in parts of Canada, a national, standardised surveillance system does not currently exist to confirm these suspicions or identify the risks associated with acquiring a resistant GC infection.

Methods Currently, laboratory-based surveillance of GC AMR is standard practise for all positive gonorrhoea isolates tested by culture in Canada. Nine out of 13 provinces/territories employ culture for a proportion of the total gonorrhoea tests done in their jurisdictions (typically conducted by local/regional laboratories). Variation in methods at the provincial/territorial (P/T) level and limited epidemiologic data on resistant GC isolates limits national level surveillance.

To address gaps in current systems, a national protocol for GC AMR has been developed and approved by the Health Canada-Public Health Agency of Canada Research Ethics Board, and recruitment of P/T health authorities is in progress. Due to P/T variations in public health legislation and health care practises, recruitment has necessitated innovative solutions to address the individual needs of jurisdictions while ensuring the coherence and comparability of the resulting data.

Results In 2011, the proportion of GC isolates resistant to azithromycin, penicillin, erythromycin, ciprofloxacin and tetracycline was 0.4%, 22.2%, 26.6%, 29.3%, and 29.4%, respectively. Enhanced surveillance in two jurisdictions is expected to commence in 2013. Although slightly different mechanisms are being used to address provincial needs, efforts are being made to ensure that resulting data are consistent and adhere to the national protocol.

Conclusion In Canada, surveillance of GC AMR is challenged by variations in practise and legislation at the P/T level and competing priorities at all levels of government. Through collaboration with public health partners, progress is being made in obtaining data for analysis of national-level trends to assess risk factors associated with GC AMR and guide treatment recommendations.