Gonococcal Antimicrobial Surveillance Program — Canada (GASP-Canada): Antimicrobial resistance:
The Gonococcal Antimicrobial Surveillance Program — Canada (GASP-Canada) monitors antimicrobial resistance (AMR) in gonorrhea across Canada.
- Last updated: 2025-06-09
GASP-Canada tests for antimicrobial resistance (AMR) on gonorrhea cultures submitted to the National Microbiology Laboratory (NML). We test a variety of antimicrobials to identify resistance trends. We determine AMR through minimum inhibitory concentrations (MICs). An MIC is the lowest concentration of antimicrobial that prevents the growth of a bacterium. MICs are determined through either:
- agar dilutionFootnote 1
- whole-genome sequencing (detecting specific molecular markers to predict resistance)Footnote 2
Some provinces and territories also contribute their own MIC data. Their data is included in GASP-Canada's overall analysis.
On this page
- Gonococcal antimicrobial resistance rates
- Recommended antimicrobials for gonorrhea treatment
- Multi-drug and extensive drug resistance
Gonococcal antimicrobial resistance rates
Figure 1. Antimicrobial resistance rates of N. gonorrhoeae cultures submitted to GASP-Canada,
-
Figure 1: Text description
Table 1. AMR minimum inhibitory concentration (MIC) cut-off points of GASP-Canada
| Antimicrobial | MIC interpretive standard (mg/L) | |||
|---|---|---|---|---|
| Susceptible | Intermediate | Decreased Susceptibility | Resistant | |
| Penicillin | ≤ 0.06 | 0.12 - 1.0 | - | ≥ 2.0Footnote 3 |
| Tetracycline | ≤ 0.25 | 0.5 - 1.0 | - | ≥ 2.0Footnote 3 |
| Ciprofloxacin | ≤ 0.06 | 0.12 - 0.5 | - | ≥ 1.0Footnote 3 |
| Ceftriaxone | < 0.125Footnote 3 | - | 0.125Footnote 4 | ≥ 0.25Footnote 6 |
| Cefixime | < 0.25Footnote 3 | - | 0.25Footnote 4 | ≥ 0.5Footnote 6 |
| Azithromycin | < 2.0 | - | - | ≥ 2.0Footnote 3 |
Recommended antimicrobials for treatment
The Public Health Agency of Canada (PHAC) publishes treatment guidance for gonorrhea infections. Until 2024, the treatment was 250 mg of ceftriaxone or 800 mg of cefixime with 1 g azithromycin. As of December 23, 2024, the treatment is monotherapy with 500 mg of ceftriaxone.
PHAC's recommended treatment regimens for gonorrheaFigure 2. Trends of decreased susceptibility or resistance to recommended antimicrobials (cefixime, ceftriaxone, and azithromycin) in Canada, to
Figure 2: Text description
In 2012, the World Health Organization (WHO) introduced a Global Action Plan to control the spread and impact of antimicrobial resistance in N. gonorrhoeae. The WHO advises that treatments be reviewed when resistance rates reach 5%. Resistance to azithromycin in Canada has passed this threshold. Cases of resistance to ceftriaxone and cefixime have also been detected. These factors signal the need for careful monitoring and potential adjustments to treatment.
Multi-drug and extensive drug resistance
GASP-Canada also keeps track of rates of multi-drug resistant gonorrhea (MDR-GC) and extensively drug-resistant gonorrhea (XDR-GC).
MDR-GC is:
- decreased susceptibility or resistance to 1 currently or recently recommended therapy (either cephalosporin OR azithromycin)
- resistance to at least 2 other antimicrobials tested
XDR-GC is:
- decreased susceptibility or resistance to 2 currently or recently recommended therapies (cephalosporin AND azithromycin)
- resistance to at least 2 other tested antimicrobials
Figure 3. Trends of N. gonorrhoeae in Canada
Figure 3: Text description
References
- Footnote 1
-
CLSI. Performance Standards for Antimicrobial Susceptibility Testing. 34th ed. CLSI supplement M100. Clinical and Laboratory Standards Institute; 2024.
- Footnote 2
-
Demczuk W, Martin I, Sawatzky P, Allen V, Lefebvre B, Hoang L, Naidu P, Minion J, VanCaeseele P, Haldane D, Eyre DW, Mulvey MR. Equations To Predict Antimicrobial MICs in Neisseria gonorrhoeae Using Molecular Antimicrobial Resistance Determinants. Antimicrob Agents Chemother. 2020 Feb 21;64(3):e02005-19. doi: 10.1128/AAC.02005-19. PMID: 31871081; PMCID: PMC7038236.
- Footnote 3
-
World Health Organization, Department of Reproductive Health and Research. Global action plan to control the spread and impact of antimicrobial resistance in Neisseria gonorrhoeae. 2012. [cited 2024 Oct 07].
- Footnote 4
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Unemo M, Fasth O, Fredlund H, Limnios A, Tapsall J. Phenotypic and genetic characterization of the 2008 WHO Neisseria gonorrhoeae reference strain panel intended for global quality assurance and quality control of gonococcal antimicrobial resistance surveillance for public health purposes. J Antimicrob Chemother. 2009 Jun;63(6):1142-51. doi: 10.1093/jac/dkp098. Epub 2009 Mar 24. PMID: 19318360.
- Footnote 5
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Daly CC, Hoffman I, Hobbs M, Maida M, Zimba D, Davis R, Mughogho G, Cohen MS. Development of an antimicrobial susceptibility surveillance system for Neisseria gonorrhoeae in Malawi: comparison of methods. J Clin Microbiol. 1997 Nov;35(11):2985-8. doi: 10.1128/jcm.35.11.2985-2988.1997. PMID: 9350775; PMCID: PMC230103.
- Footnote 6
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Tang Y, Liu X, Chen W, Luo X, Zhuang P, Li R, Lin X. Antimicrobial Resistance Profiling and Genome Analysis of the penA-60.001 Neisseria gonorrhoeae Clinical Isolates in China in 2021. J Infect Dis. 2023 Sep 15;228(6):792-799. doi: 10.1093/infdis/jiad258. PMID: 37462263.
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