Background N. gonorrhoeae azithromycin resistance (MIC ≥ 2 mg/L) increased from 1.7% to 30.9% between 2013 and 2017 in Quebec, Canada. The Quebec sentinel network aims to 1) maintain a sufficient number of cultures for antimicrobial resistance surveillance; 2) link antimicrobial susceptibility surveillance to epidemiological and clinical information; and 3) monitor treatment failures. We herein examine the associations between N. gonorrhoeae azithromycin resistance and epidemiological/clinical characteristics.

Methods Three regions participated: Montréal (two clinics recruiting mostly men having sex with men (MSM)), Montérégie (22 clinics recruiting mostly heterosexuals) and Nunavik (participated only in 2016, recruited mainly heterosexual Inuit people). One strain per year, per individual was selected. When data was presented for 2015–2017 (2015 was incomplete), the most recent strain per individual was considered. Proportions were compared using chi-square tests.

Results Between September 2015 and December 2017, 68% of episodes (840/1240) had a culture performed and 571 strains were obtained, including all duplicates. This analysis includes 190 strains in 2016, 270 strains in 2017 and 469 strains for 2015–2017. Most isolates were collected in MSM (349/469; 76%). Sampling sites were urethra (329/469; 70.2%), rectum (90/469; 19.2%) and pharynx (50/469; 10.7%). Azithromycin resistance was significantly higher in MSM (25.5% vs 9.2% in heterosexuals, p<0.001), in cases who reported previous gonorrhea (27.3% vs 15.3%, p=0.004), syphilis (29.5% vs 19.8%, p=0.045), HIV (31.8% vs 20.1%, p=0.035) and who reported a sex partner outside Quebec in 2016 (36.7% vs 16.8%, p=0.021), but this difference was not maintained in 2017 (21.2% vs 21.7%, p=0.951). No significant difference was observed with regard to age, number of sex partners, anatomical site and presence of symptoms.

Conclusion Recommendations to perform cultures appear to be well implemented (70% of episodes). Azithromycin resistance seems to be well established in Quebec with a possible declining contribution of travel-acquired resistant infection.

Disclosure No significant relationships.