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About Sickkids
About SickKids

February 2, 2009

Unusually High Rates of Antibiotic-Resistant Gonorrhea

The magnitude of the rate of resistance to quinolone antibiotics in Ontario is unusually high by any threshold reported in North America.

Gonorrhea resistant to the quinolone class of antibiotics has increased rapidly in Ontario – from only four per cent in 2002 to 28 per cent in 2006, according to a study that has been published in the CMAJ.

“Given Ontario’s large population and its status as a major economic centre and national transit hub, its epidemiology is likely to influence trends in other provinces of Canada,” says Dr. Susan Richardson, Head Division of Microbiology at The Hospital for Sick Children, Senior Associate Scientist at SickKids Research Institute, Associate Professor, University of Toronto and Medical Microbiologist, Ontario Agency for Health and Protection and Promotion.

After declining for a number of years, the incidence of gonorrhea infections has recently resurged in many parts of the world including Canada. Nationally, the number of reported cases between 1997 and 2007 has more than doubled, from 15 to 35 cases per 100,000 population.

The cause for the rise in incidence is unclear, but Dr. Richardson questions whether people have become less careful about preventing sexually transmitted infections (STIs) by the regular use of condoms. Is there more risky sexual behaviour going on in recent years? Or, alternatively, are doctors screening patients for STIs more regularly?

The health implications are serious. If left untreated, gonorrhea can cause infection of the fallopian tubes in women (pelvic inflammatory disease), that can in turn lead to ectopic pregnancy and infertility. It can also be transmitted from the mother to her newborn child.

As for the rising rates of resistance, Dr. Richardson says it likely due, at least in part, to the import by travellers, of resistant strains from other areas of the world, especially southeast Asia, in which rates of resistance are very high. The use of quinolones for the treatment of other infections, such as community-acquired pneumonia and urinary tract infections may also be contributing. The occurrence in Ontario of multiple different strains of quinolone-resistant Neisseria gonorrhoeae suggests that these strains come from multiple sources, including the development of resistance by Canadian strains.

The findings support the current recommendations by the Public Health Agency of Canada, that doctors not use quinolines as the first line of treatment for this infection. It also underscores the need for people to remain vigilant and protect themselves from STIs by adhering to safe sex practices.