Males accounted for at least 56% of all cases diagnosed. The number of cases reported in 2016 was more than double the number reported in 2010 (rising from 33.5 to 65.4 per 100,000 population), corresponding to a 95% increase in rates. Rates of gonorrhea have been increasing steadily over the last few years. Due to the documented increase in rates of gonorrhea and AMR-GC, PHAC is identifying the need for concerted clinical and public health action. The Public Health Agency of Canada (PHAC) provides annual national data on GC infection rates ( 2), laboratory surveillance of AMR-GC ( 3), and recommendations on the prevention, early detection and treatment of gonorrhea in the Canadian Guidelines on Sexually Transmitted Infections (CGSTI) ( 4). The World Health Organization (WHO) estimates that 78 million people are infected with GC annually, as a result of decreased condom use, increased urbanization and travel, poor infection detection rates and inadequate or failed treatment ( 1). Although GC is treatable, global rates continue to rise. Increasing antimicrobial resistance (AMR) in Neisseria gonorrhoeae, seen both domestically and internationally, combined with rising rates of gonococcal (GC) infection, are a serious public health concern. Finally, refer to the most current Canadian Guidelines on Sexually Transmitted Infections or provincial/territorial recommendations on combination therapies for patients and their contacts as recommendations may have changed in response to evolving AMR-GC trends. Third, use culture along with NAAT to establish the diagnosis and follow up for test-of-cure. Second, conduct pretravel counselling and include a travel history as part of the risk assessment. NAAT is useful for screening, but culture is still needed for extra-genital sites. First, normalize and increase GC screening based on risk factors and emphasize the need for safer sex practices. There are four key actions that clinicians and front-line public health professionals can take to stem the increase in rates of GC and drug resistant GC. The new screening and diagnostic Nucleic Acid Amplification Test (NAAT) is excellent but has decreased the number of cultures being done and therefore our capacity to track AMR-GC. Sexual contact during travel is an important source of imported emerging resistant global strains. Treatment is complex: recommendations vary by site of infection and risk of resistance. People may hesitate to seek testing (or to offer testing).
GC infection is often asymptomatic and it is highly transmissible. There are a number of reasons why we are facing this public health threat. The presence of GC can also increase the risk of HIV acquisition and transmission. Otherwise, we will be faced with the possibility of persistent GC infection which can lead to pelvic inflammatory disease, infertility and chronic pelvic pain in women and epididymitis in men. It is important that coordinated efforts be made now to ensure these new global strains do not become established in Canada. The current recommendation for combination therapy is now being threatened by globally emerging and increasingly resistant strains. Previously recommended treatments are ineffective against many of the gonorrhea strains circulating today. Increasing rates of gonococcal (GC) infection and antimicrobial resistant (AMR) GC, are a serious public health concern for Canada and around the world.
0 kommentar(er)
