1. Antimicrobial Resistance in N. gonorrhoeae: In Brief 2014 INTRODUCTION Increased action is needed to help prevent and control gonorrhea. Worldwide antimicrobial resistance is an emerging public health threat.

2. Antimicrobial Resistance in N. gonorrhoeae: In Brief 2014 KEY ISSUES Resistance to cephalosporins particularly observed among MSM* Reported cases of gonococcal infection in Canada have increased since 1997 Gonococcal infections have been resistant to existing drug therapies Progressive resistance to penicillin, tetracycline &quinolones. Decreased susceptibility to third generation oral & injectable cephalosporins * Men Who Have Sex With Men

3. Antimicrobial Resistance in N. gonorrhoeae: In Brief 2014 DIAGNOSIS Cultures are particularly important in the following situations: Suspected pelvic inflammatory disease In cases of suspected or increased probability of treatment failure MSM who are symptomatic If the infection was acquired in a geographical area with high rates of antimicrobial resistance Depending on clinical situation, consider collecting both cultures and NAAT especially in symptomatic patients

4. Antimicrobial Resistance in N. gonorrhoeae: In Brief 2014 TREATMENT Monotherapy should be avoided in order to help prevent resistance The above based on Public Health Agency of Canada’s Canadian STI Guidelines: http://www.phac-aspc.gc.ca/std-mts/sti-its/cgsti-ldcits/section-5-6-eng.php Patients should be treated with combination therapy (two antibiotics) For MSM, the preferred therapy for uncomplicated anogenital and pharyngeal infection is: ceftriaxone 250 mg IM PLUS azithromycin 1 g oral For other adults and youth (≥ 9 years), the preferred therapy for uncomplicated anogenital and pharyngeal infection is: ceftriaxone 250 mg IM PLUS azithromycin 1 g oral For uncomplicated anogenital infection only: cefixime 800 mg oral PLUS azithromycin 1 g oral (not appropriate for pharyngeal infections)

5. Antimicrobial Resistance in N. gonorrhoeae: In Brief 2014 FOLLOW-UP 3-7 days later  Culture All sexual partners within 60 days prior to symptom onset should be notified, tested and empirically treated 2-3 Weeks later  NAAT Repeat screening for individuals with a gonococcal infection is recommended 6 months post-treatment Test of Cure Post-Treatment

6. Antimicrobial Resistance in N. gonorrhoeae: In Brief 2014 REPORTING Cases of gonorrhea must be reported to public health officials Treatment failures should also be reported TREATMENT FAILURE is defined as one of the following in the absence of reported sexual contact during post-treatment period: Positive N. gonorrhoeae on culture taken at least 72 hrs. after treatment Positive NAAT taken at least 2-3 weeks after treatment Presence of intracellular Gram- negative diplococci on microscopy taken at least 72 hrs. after treatment

7. Antimicrobial Resistance in N. gonorrhoeae: In Brief 2014 To successfully address the public health risk of antimicrobial resistant gonorrhea, all primary care and public health professionals must work together. CONCLUSION