Neisseria gonorrhoeae is a strictly human pathogen that causes a sexually transmitted infection (STI) known as gonorrhea (38). Gonorrhea usually manifests as urethritis and cervicitis, but can also present as rectal and pharyngeal infections. If left untreated, gonorrhea can lead to serious complications, including pelvic inflammatory disease, ectopic pregnancy, infertility, epididymitis and, in rare cases, can penetrate sterile sites to become a disseminated gonococcal infection (39). The presence of gonorrhea can also increase the risk of HIV acquisition and transmission (40).
In Canada, gonorrhea has been nationally reported since 1924 and is the second most frequently reported bacterial sexually transmitted infection (STI), with rates increasing for almost two decades (41) (42). Increasing antimicrobial resistance has been documented in N. gonorrhoeae isolates, including the development of multidrug resistance (MDR) and ultra-drug resistance (UR) (43) (44). Worldwide and in Canada, N. gonorrhoeae isolates with reduced susceptibility to extended-spectrum cephalosporins and increased resistance to azithromycin have been reported. The identification of URM isolates has led the World Health Organization (WHO) to warn that gonorrhea may become untreatable due to resistance to all available antimicrobial classes (39) (40).
