The Windsor-Essex County Health Unit (WECHU) is sharing an important alert from the Canadian Network for Public Health Intelligence (CNPHI) with regards to two additional cases of ceftriaxone-resistant Neisseria gonorrhoeae (NG) identified in Canada. This brings the total number of ceftriaxone-resistant cases identified in 2024 to eight¹. Both cases were male and reported female sexual partners. One case reported recent travel to a region with high antimicrobial resistance (AMR) prevalence and the other with no travel history, suggesting possibly locally acquired. These additional two cases, like the other six cases, both had isolates that were resistant to ceftriaxone and cefixime and demonstrated multidrug resistance.¹

The Public Health Agency of Canada (PHAC) published interim guidance on December 23, 2024, for the treatment of uncomplicated gonococcal infections.¹ The following information reiterates this guidance and replaces the 'Public health actions to consider' shared in the original CNPHI alert on December 4, 2024:¹

Preferred Treatment:¹

The National Advisory Committee on Sexually Transmitted and Blood-Borne Infections (NAC-STBBI) now recommends ceftriaxone 500 mg IM as monotherapy (single dose) as the preferred treatment for uncomplicated NG infections in individuals 10 years of age and older.

Specimen Collection:¹

Health care providers are encouraged to collect specimens for both NG culture and antimicrobial susceptibility testing and nucleic acid amplification testing (NAAT) in the following situations:

• When patients are symptomatic, including those with suspected treatment failure
• When assessing pregnant individuals
• When assessing contacts of confirmed NG cases
• When sexual abuse or assault is suspected
• When infections may have been acquired in areas with high rates of antimicrobial resistance
• Prior to treating individuals whose NG infection was detected only by NAAT, if collecting a specimen for culture does not delay treatment

Test of Cure (TOC):¹

• A NG TOC is recommended for all positive sites in all cases
• If the NG TOC is performed between 3 days and 3 weeks after treatment completion, a culture should be performed
• If the NG TOC is performed more than 3 weeks after treatment completion, NAAT should be performed

Report: 

Timely reporting of suspected or confirmed cases of communicable diseases is essential for their control.

• Report ceftriaxone-resistant gonococcal isolates or suspected treatment failures along with all cases of Neisseria gonorrhoeae infection to the Infectious Disease Department at the WECHU.
• Reporting forms are available on the WECHU website and should be filled out completely and faxed to 226-783-2132.

Health Teaching:¹

• Continue to encourage sexually active individuals in your jurisdiction to utilize safer sex practices (e.g., use of barrier methods such as condoms and dental dams for vaginal, anal and oral sex) with new partners to curb gonorrhea infections.¹
• Condoms are available free of charge at the WECHU, to request a bulk order, visit our webpage and click “contact us for condom request”. 

For questions or concerns, please call 519-258-2146 ext. 1420 during regular office hours, You can also visit our website.

For more information, 

1. Canadian Network for Public Health Intelligence (CNPHI), 2025: Posted Alert. Subject: Addendum: 8 cases of ceftriaxone-resistant gonorrhea.
2. Public Health Agency of Canada (PHAC), 2025. Gonorrhea Guide: Treatment and Follow-Up