Background Incident cases of gonococcal infection are increasing. Antibiotic resistance may compromise the effectiveness of treatment. In 2017, the proportion of azithromycin-resistant strains reached 31% in Quebec and a first strain non-susceptible to ceftriaxone and cefixime was detected.

Methods Since November 2014, public health departments are invited to report possible cases of treatment failures. Clinical and epidemiological information is collected using a standardized form for each report of gonococcal infection occurring <42 days after a previous episode in the same person. Antimicrobial susceptibility testing (AST) is conducted at the provincial reference laboratory (Laboratoire de santé publique du Québec) and the NG-MAST typing is performed at the National Microbiology Laboratory. Cases are classified as retained (presence of all definition criteria) or suspected (not meeting all criteria but reinfection unlikely). Cases classifications are validated by a group of experts. Lack of re-exposure is based on the respondent’s reported sexual history between the first treatment and the test of cure (TOC). Case definitions are consistent with those of Quebec and Canadian sentinel surveillance network for gonococcal infection.

Results Between November 2014 and December 2018, 44 cases of possible treatment failures were reported. After exclusion of 9 cases, 35 were analysed (25 classified as retained and 10 as suspected). There were 10 women, 24 men (68% MSM) and one trans person. Pharynx was identified as site of treatment failure for 14 cases (40%). AST were available for 23 cases (66%): 78% were resistant to ciprofloxacin and 43% to azithromycin. All strains were susceptible to cephalosporins, but one strain showed reduced susceptibility to cefixime. Eleven cases (31%) received azithromycin monotherapy as initial therapy.

Conclusion Treatment failure exist and is not always related to documented resistance. This analysis probably underestimates the real extent of treatment failures since it requires TOC that are not systematically collected. Reinfection cannot be completely excluded.

Disclosure No significant relationships.