Background Neisseria gonorrhoeae is becoming increasingly resistant to the antibiotics used and many countries reported therapeutic failures. The WHO published a global action plan on antimicrobial resistance. Several measures were undertaken in Québec including the use of a dual therapy. Since 2015, the provincial sentinel network aims to 1) maintain sufficient cultures for the surveillance of antimicrobial resistance 2) complement the reference laboratory antimicrobial surveillance by providing epidemiological and clinical information and 3) complement the surveillance of treatment failures.

Methods Two clinics specialized in STBBIs and several general practitioners, located in three regions (Montreal, Montérégie, Nunavik) are enrolled. Epidemiological and clinical data (including reasons for visits, laboratory samples and treatments prescribed) of gonococcal infections are collected on a centralized secured web application. Cases are classified as retained treatment failures (presence of all predefined criteria) or suspected treatment failures.

Results From September 2015 to December 2017, 1240 episodes in 1115 individuals were recorded (111 women, 1000 men, 3 transgender, 1 unknown sex). At least 83% of the precribed treatments fully respected the recommended first-line treatments (ceftriaxone 250 mg or cefixime 800 mg in combination with azithromycin 1g). Among the 731 (59%) episodes with a test of cure performed, 47 (6.4%) were positive; specific questionnaires for the treatment failure assessment were available for 28. After analysis, 5 episodes were classified as retained or suspected treatment failure, including 4 pharyngeal infections and 2 cases who received azithromycin monotherapy. In 2018 (preliminary data), 15 additional assessment questionnaires were completed, adding 5 treatment failures (3 suspected and 2 retained).

Conclusion The results of the sentinel network help to guide Quebec public health decision-making. When certain B-lactam allergy forces clinicians to prescribe an alternative treatment, a dual therapy including gentamicin is now recommended. Overrepresentation of azithromycin monotherapies among treatment failures in the sentinel network also contributed to this recommendation change.

Disclosure No significant relationships.