Increasing rates of gonococcal (GC) infection and antimicrobial resistant (AMR) GC, are a serious public health concern for Canada and around the world. Previously recommended treatments are ineffective against many of the gonorrhea strains circulating today. The current recommendation for combination therapy is now being threatened by globally emerging and increasingly resistant strains. It is important that coordinated efforts be made now to ensure these new global strains do not become established in Canada. Otherwise, we will be faced with the possibility of persistent GC infection which can lead to pelvic inflammatory disease, infertility and chronic pelvic pain in women; and epididymitis in men. The presence of GC can also increase the risk of HIV acquisition and transmission. There are a number of reasons why we are facing this public health threat. GC infection is often asymptomatic and it is highly transmissible. People may hesitate to seek testing (or to offer testing). Treatment is complex: recommendations vary by site of infection and risk of resistance. Sexual contact during travel is an important source of imported emerging resistant global strains. The new screening and diagnostic Nucleic Acid Amplification Test (NAAT) is excellent but has decreased the number of cultures being done and therefore our capacity to track AMR-GC. There are four key actions that clinicians and front-line public health professionals can take to stem the increase in rates of GC and drug resistant GC. First, normalize and increase GC screening based on risk factors and emphasize the need for safer sex practices. NAAT is useful for screening, but culture is still needed for extra-genital sites. Second, conduct pretravel counselling and include a travel history as part of the risk assessment. Third, use culture along with NAAT to establish the diagnosis and follow up for test-of-cure. Finally, refer to the most current Canadian Guidelines on Sexually Transmitted Infections or provincial/territorial recommendations on combination therapies for patients and their contacts as recommendations may have changed in response to evolving AMR-GC trends.

Les taux croissants d'infections gonococciques et de résistance aux agents antimicrobiens observés soulèvent de sérieuses préoccupations en matière de santé publique au Canada et dans le monde entier. Les traitements autrefois recommandés sont devenus inefficaces contre un grand nombre de souches de gonorrhée aujourd'hui omniprésentes. La recommandation actuelle misant sur la thérapie combinée est maintenant menacée par les souches émergentes de provenance internationale qui sont de plus en plus résistantes aux antibiotiques. Il est important de coordonner nos efforts afin d'éviter que ces nouvelles souches mondiales ne s'implantent au Canada; sans quoi nous pourrions voir évoluer ces infections gonococciques persistantes pouvant conduire à la maladie inflammatoire pelvienne, à la stérilité et à la douleur pelvienne chronique chez les femmes et à l'épididymite chez les hommes. La présence d'une infection gonococcique peut aussi accroître le risque de contracter et de transmettre le VIH.