Antimicrobial resistance in gonorrhea: the influence of epidemiologic and laboratory surveillance data on treatment guidelines: Alberta, Canada 2001-2007.

OBJECTIVES: To describe the impact of surveillance for antimicrobial resistance (AMR) in Neisseria gonorrhoeae over a 7-year period on treatment guidelines in Alberta, Canada. METHODS: AMR testing data from gonorrhea cases were combined with demographic and risk behavior information collected through surveillance to describe trends and sequential changes to treatment guidelines. RESULTS: Ciprofloxacin resistant gonorrhea (CRG) cultures rose from 1.4% in 2001 to 27.7% in 2007. Of 200 CRG cases, 90% were men, 77% white, median age 29 years (interquartile range: 23-29 years) and 60% were men who have sex with men (MSM). In 2005, only 1 of 28 cases did not fit into travel or MSM categories and treatment guidelines were changed to recommend oral cefixime as the preferred agent in MSM or those with a travel history. Continuous rise in CRG together with locally acquired cases among heterosexuals resulted in ciprofloxacin being removed as a recommended agent for gonorrhea in 2007. CONCLUSIONS: Our data underscores the importance of surveillance in monitoring trends in AMR in gonorrhea so that timely changes to treatment recommendations can be made in response to changing epidemiology.