Background Neisseria gonorrhoeae, the causative agent of gonorrhea, is the second most commonly reported bacterial sexually transmitted infection in Canada and a global public health threat. Many cases of gonococcal infection include isolates from more than one anatomical infection site. This study compares the antimicrobial resistance (AMR) and molecular sequence type (ST) of multiple anatomical infection site isolates from individual cases.
Methods Isolates were collected by Canadian provincial laboratories and submitted to the National Microbiology Laboratory (NML) from 2016–2017. AMR profiles were determined using agar dilution as described by the Clinical Laboratory Standards Institute. Molecular genotyping was determined using N. gonorrhoeae multi-antigen sequence typing (NG-MAST).
Results In 2016–2017, NML received 8,300 N . gonorrhoeae isolates; 668 of the isolates were associated with multiple infection sites from a total of 307 cases. Of the 307 cases, 92.8% (n=285) had isolates with similar AMR profiles and the same NG-MAST ST. Twenty-two cases (7.2%) with isolates originating from multiple infection sites were found to have different AMR profiles and different STs. Of the 134 cases with throat and rectal isolates, 3.7% (5/134) had isolates with different STs. Of the 144 cases with both urogenital and rectal isolates, 6.3% (9/144) of isolates had different STs. Of the 132 cases with both urogenital and throat isolates, 9.9% (13/132) had different STs. Three cases had all three infections sites (throat, rectal and urogenital), each with different AMR profiles and different ST types.
Conclusion The majority of gonococcal cases with isolates from multiple infection sites have the same AMR profile and ST indicating a single infection. Approximately 7% of gonococcal cases with multiple infection site isolates were found to have very different AMR profiles and sequences types which may have implications in test-of-cure strategies, treatment failure investigations and surveillance programs.
Disclosure No significant relationships.
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