Background In Toronto, gonorrhea is the second most commonly reported sexually transmitted infection, after chlamydia. From 2000 to 2012, rates of gonorrhea in Toronto were stable, ranging from 56/100,000 to 72/100,000. However, rates started to rise in 2013. In 2018, rates increased by 37% from 2017, the largest observed annual increase since 2000, reaching a high of 158/100,000. This study aimed to describe gonorrhea trends in Toronto between 2012 and 2018.
Methods Data for gonorrhea cases reported between 2012 and 2018 were extracted from the integrated Public Health Information System on January 29 2019. Analyses were conducted in SAS 9.4.
Results In 2018, 4,549 gonorrhea cases were reported in Toronto, 135% higher than 1,939 cases (71/100,000) reported in 2012. The increase was driven by a rise in reports among males, increasing by 192% while females increased by 24%; males comprised 81% of cases in 2018. Males most commonly reported engaging in sex with men (MSM), and the proportion with this risk factor increased from 55% in 2012 to 69% in 2018. Conversely, the proportion of males reporting sex with women declined from 25% in 2012 to 17% in 2018. Females in 2018 most commonly reported not using a condom (77%) in the last sexual encounter, slightly higher than 2012 (71%). In 2018, 38% of cases (44% of males, 9% of females) had rectum and/or pharyngeal gonorrhea, higher than 20% of cases in 2017.
Conclusion The rising rates in gonorrhea, particularly among MSM, may be due to changes in screening guidelines in 2013 that included extragenital screening of gonorrhea. In April 2018, both rectal and pharyngeal specimens were approved for Nucleic Acid Amplification Testing in Ontario, potentially playing a role in the additional increase in 2018. This study demonstrates that it is important that physicians continue to screen for extragenital gonorrhea among MSM.
Disclosure No significant relationships.
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