Background Surveillance for antimicrobial resistance (AMR) in Neisseria gonorrhoeae (NG) is critical to monitor trends and to inform treatment guidelines for NG. In Nunavut (NU), a Canadian Arctic territory, culture for NG is not possible due to environmental conditions which affect organism viability. Specimens submitted for nucleic acid amplification tests (NAAT) are routinely used to screen for NG and have the potential to provide important surveillance information with additional testing.

Methods In January, 2018, Nunavut commenced submission of Roche-Cobas NG positive NAAT specimens to the National Microbiology Laboratory (Winnipeg, Canada). Samples were sequenced using Neisseria gonorrhoeae multi-antigen sequence typing (NG-MAST). Real-time (RT-) PCR assays were used to detect single nucleotide polymorphisms (SNPs) in genes associated with ciprofloxacin resistance (gyrA, parC) and azithromycin resistance (23S rRNA).

Results From January to September, 2018, 257 samples were submitted to NML. 229 samples were typeable and 21 different NG-MAST STs were identified, of which approximately half are unique to NU. The most prevalent ST was ST16840 (34.5%, 79/229) which is associated with ciprofloxacin resistance and is closely related to ST 10451, a common sequence type identified across Canada. 28.5% (66/229) were ST5985, a common ST circulating in Canada and is associated with tetracycline resistance. Fully susceptible ST 4637 represented 10.5% (24/229) specimens. Of 216 specimens, 92 were predicted to be ciprofloxacin resistant and of 218 specimens; less than five samples were predicted to be azithromycin resistant.

Conclusion Data from Nunavut, a Canadian Arctic region where the collection of NG culture is not feasible, support the use of NAAT positive NG specimens to provide enhanced surveillance to monitor the types of NG circulating in a community and ensure that currently recommended therapies are appropriate. Future surveillance initiatives linking the samples to epidemiologic data has the potential to support additional public health interventions in at-risk populations.

Disclosure No significant relationships.