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Gonorrhea, an infection caused by Neisseria gonorrhoeae, has been nationally notifiable since 1924 and remains the second most commonly reported bacterial sexually transmitted infection in Canada. Untreated infections can lead to complications for both sexes, with more severe consequences for women. A serious, common complication affecting women is pelvic inflammatory disease, which can lead to chronic abdominal pain, infertility, and ectopic pregnancy. In men, untreated infections can result in epididymitis and rare cases of infertility. An uncommon complication of gonorrhea is the spread of infection to the blood stream and joints3. Like other non-ulcerative STIs, gonorrhea can increase the risk of HIV acquisition and transmission possibly by increasing the concentration of cells in genital secretions. These cells can serve as targets for HIV thereby increasing the risk of acquiring and/or transmitting the virus2b.
While reported rates of gonorrhea infections in Canada continue to rise in both sexes, the increase is being driven by women in more recent years.
Reported rates of gonococcal infections in 2008 were highest in the younger population.
Figure 6: Reported Rates of Gonorrhea by Sex and Age Group, 2008, Canada
Reported rates of gonococcal infections increased consistently over time across age groups in both males and females aged 15 and older.
Figure 7: Reported Rates of Gonorrhea in Males by Age Group, 1999 to 2008, Canada
Figure 8: Reported Rates of Gonorrhea in Females by Age Group, 1999 to 2008, Canada
While the reported rates were highest in Nunavut and the Northwest Territories, the Prairie Provinces have seen substantial increases between 1999 and 2008.
|Jurisdiction||Number of Cases||Rate per 100,0003||Rate Change (%)|
1 Rate change calculated using unrounded values.
2 Nunavut did not officially become a territory until 1999; prior to 1999, data for Nunavut was combined with Northwest Territories. Rate change for NT was not calculated since 1999 rates are not comparable with 2008 rates due to the creation of Nunavut.
* The rate change cannot be quantified.
3 Bolded rates indicate rates above national average.
|Jurisdiction||Male-to-Female Rate Ratio|
|Canada||1.3 : 1.0|
|BC||1.8 : 1.0|
|AB||1.3 : 1.0|
|SK||0.7 : 1.0|
|MB||0.8 : 1.0|
|ON||1.4 : 1.0|
|QC||1.8 : 1.0|
|NB||1.1 : 1.0|
|NS||1.1 : 1.0|
|PE||0.3 : 1.0|
|YT||0.7 : 1.0|
|NT||1.0 : 1.0|
|NU||1.0 : 1.0|
Uncomplicated gonorrhea can be treated with single dose oral or injectable antibiotics. The challenge arises when resistant strains are treated with antibiotics to which the bacteria have decreased susceptibility. When this occurs, there is increased likelihood of transmission due to treatment failure and the development of adverse sequelae unless the resistant organism is identified and treated appropriately. Gonococcal resistance to penicillin, erythromycin and tetracycline is long established, while ciprofloxacin resistance has developed more recently4-6. None of these antibiotics are currently recommended as preferred treatments in the Canadian Guidelines on Sexually Transmitted Infections1b.
Figure 9: Antimicrobial Susceptibility of Neisseria gonorrhoeae Strains Tested in Canada, 1999-2007
* Percentages are calculated using the number of all GC cultures tested in each province, including susceptible and resistance cultures, as the denominator.
There are no resistant strains for spectinomycin, cefixime, and ceftriaxone.