{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T03:53:25Z","timestamp":1779335605058,"version":"3.51.4"},"reference-count":51,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2025,11,6]],"date-time":"2025-11-06T00:00:00Z","timestamp":1762387200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Antibiotics"],"abstract":"<jats:p>Background\/Objectives: Neisseria gonorrhoeae can develop resistance to antimicrobial treatments, posing a challenge to effective management of patients. Alberta, Canada, monitors the antimicrobial susceptibility of gonorrhea isolates to track resistance trends. This study aims to retrospectively analyze susceptibility data and demographic trends from gonorrhea cases in the province over a seven-year period. Methods: Antimicrobial susceptibility testing was performed using gradient strip methodology on gonorrhea isolates from Alberta, evaluating both historical and currently recommended antimicrobials for treatment of gonorrhea. Susceptibility testing results were interpreted using Clinical and Laboratory Standards Institute (CLSI) breakpoints. Provincial antimicrobial susceptibility testing data were analyzed using STATA v.17, incorporating antimicrobial resistance patterns and demographic information from provincial databases. Results: Between 2016 and 2022, 4056 N. gonorrhoeae isolates were cultured from 3617 individuals. All isolates tested were susceptible to ceftriaxone and cefixime, except for a single resistant isolate in 2018. Azithromycin susceptibility ranged from 99% to 88%, with the lowest susceptibility observed in 2018. Males exhibited higher rates of antimicrobial non-susceptibility than females across all drugs tested, except for tetracycline. Conclusions: Ongoing antimicrobial susceptibility surveillance in Alberta is crucial for identifying resistance trends and informing the development of effective treatment strategies for gonorrhea.<\/jats:p>","DOI":"10.3390\/antibiotics14111119","type":"journal-article","created":{"date-parts":[[2025,11,6]],"date-time":"2025-11-06T17:51:43Z","timestamp":1762451503000},"page":"1119","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Surveillance of Antimicrobial Resistance in Neisseria gonorrhoeae in Alberta from 2016\u20132022"],"prefix":"10.3390","volume":"14","author":[{"given":"Taylor M.","family":"Walsh","sequence":"first","affiliation":[{"name":"Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB T6G 1C9, Canada"},{"name":"Women and Children\u2019s Health Research Institute (WCHRI), University of Alberta, Edmonton, AB T6G 1C9, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sabrina S.","family":"Plitt","sequence":"additional","affiliation":[{"name":"School of Public Health, University of Alberta, Edmonton, AB T6G 1C9, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6936-406X","authenticated-orcid":false,"given":"Tanis C.","family":"Dingle","sequence":"additional","affiliation":[{"name":"Provincial Public Health Laboratory, Alberta Precision Laboratories, Calgary, AB T2N 1M7, Canada"},{"name":"Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9129-5136","authenticated-orcid":false,"given":"Carmen L.","family":"Charlton","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB T6G 1C9, Canada"},{"name":"Women and Children\u2019s Health Research Institute (WCHRI), University of Alberta, Edmonton, AB T6G 1C9, Canada"},{"name":"Provincial Public Health Laboratory, Alberta Precision Laboratories, Edmonton, AB T6G 2J2, Canada"},{"name":"Li Ka Shing Institute of Virology, University of Alberta, Edmonton, AB T6G 2E1, Canada"},{"name":"Canadian Blood Services, Surveillance and Discovery Laboratory, Ottawa, ON K1G 4J5, Canada"},{"name":"Canadian Blood Services, Donation Policy and Studies, Edmonton, AB T6G 2R8, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,11,6]]},"reference":[{"key":"ref_1","unstructured":"Division of STD Prevention, National Center for HIV, Viral Hepatitis, STD, and and TB Prevention, Centers for Disease Control and Prevention (2025, July 29). Detailed STD Facts-Gonorrhea, Available online: https:\/\/www.cdc.gov\/sti\/?CDC_AAref_Val=https:\/\/www.cdc.gov\/std\/gonorrhea\/stdfact-gonorrhea-detailed.htm."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1038\/s41572-019-0128-6","article-title":"Gonorrhoea","volume":"5","author":"Unemo","year":"2019","journal-title":"Nat. Rev. Dis. Primers."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"e123","DOI":"10.1016\/j.amjmed.2020.06.048","article-title":"Disseminated Gonococcal Infection in an Immunosuppressed Patient","volume":"134","author":"Newman","year":"2021","journal-title":"Am. J. Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"3187","DOI":"10.3389\/fimmu.2018.03187","article-title":"Human Immune Responses and the Natural History of Neisseria gonorrhoeae Infection","volume":"9","author":"Lovett","year":"2019","journal-title":"Front. Immunol."},{"key":"ref_5","first-page":"518","article-title":"Risk factors for gonorrhoea: Case-control study","volume":"73","author":"Vlajinac","year":"1997","journal-title":"Genitourin. Med."},{"key":"ref_6","unstructured":"Public Health Agency of Canada (2025, July 29). Gonorrhea Guide: Risk Factors and Clinical Manifestations. Available online: https:\/\/www.canada.ca\/en\/public-health\/services\/infectious-diseases\/sexual-health-sexually-transmitted-infections\/canadian-guidelines\/gonorrhea\/risk-factors-clinical-manifestation.html."},{"key":"ref_7","first-page":"33","article-title":"Development of resistance of gonococci to penicillin: An eight-year study","volume":"96","author":"Amies","year":"1967","journal-title":"Can. Med. Assoc. J."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"415","DOI":"10.1136\/sti.2010.042648","article-title":"The Gonococcus fights back: Is this time a knock out?","volume":"86","author":"Lewis","year":"2010","journal-title":"Sex. Transm. Infect."},{"key":"ref_9","unstructured":"Division of STD Prevention, National Center for HIV, Viral Hepatitis, STD, and and TB Prevention, Centers for Disease Control and Prevention (2025, July 29). CDC\u2019s STI Treatment Guidelines Timeline: The Evolution of Sexual Healthcare, Available online: https:\/\/www.cdc.gov\/std\/treatment-guidelines\/timeline.htm."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"664","DOI":"10.1128\/AAC.30.5.664","article-title":"High-level tetracycline resistance in Neisseria gonorrhoeae is result of acquisition of streptococcal tetM determinant","volume":"30","author":"Morse","year":"1986","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1016\/0140-6736(90)90177-7","article-title":"Decreased susceptibility of Neisseria gonorrhoeae to ciprofloxacin","volume":"335","author":"Gransden","year":"1990","journal-title":"Lancet"},{"key":"ref_12","unstructured":"Public Health Agency of Canada (2025, July 29). Treatment of Gonorrhea in Canada. Available online: https:\/\/www.canada.ca\/en\/public-health\/services\/reports-publications\/canada-communicable-disease-report-ccdr\/monthly-issue\/2017-43\/ccdr-volume-43-2-february-2-2017\/ccdr-volume-43-2-february-2-2017-sexually-transmitted-infections.html."},{"key":"ref_13","unstructured":"Public Health Agency of Canada (2025, July 29). Gonorrhea Guide: Treatment and Follow-Up. Available online: https:\/\/www.canada.ca\/en\/public-health\/services\/infectious-diseases\/sexual-health-sexually-transmitted-infections\/canadian-guidelines\/gonorrhea\/treatment-follow-up.html."},{"key":"ref_14","unstructured":"Government of Alberta (2025, July 29). Alberta Treatment Guidelines for Sexually Transmitted Infections (STI) in Adolescents and Adults, 2018 [Updated Feb 2024]. Available online: https:\/\/open.alberta.ca\/publications\/treatment-guidelines-for-sti-2018."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1695","DOI":"10.1001\/jama.2023.15355","article-title":"Multidrug-Resistant \u201cSuper Gonorrhea\u201d Rallies Multipronged Effort","volume":"331","author":"Landhuis","year":"2024","journal-title":"JAMA"},{"key":"ref_16","unstructured":"World Health Organization (2025, July 29). Multi-Drug Resistant Gonorrhoea. Available online: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/multi-drug-resistant-gonorrhoea."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"3185","DOI":"10.1128\/AAC.48.8.3185-3187.2004","article-title":"Remarkable increase in central Japan in 2001-2002 of Neisseria gonorrhoeae isolates with decreased susceptibility to penicillin, tetracycline, oral cephalosporins, and fluoroquinolones","volume":"48","author":"Ito","year":"2004","journal-title":"Antimicrob Agents Chemother."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"2504","DOI":"10.1056\/NEJMc1512757","article-title":"Failure of Dual Antimicrobial Therapy in Treatment of Gonorrhea","volume":"374","author":"Fifer","year":"2016","journal-title":"N. Engl. J. Med."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1660","DOI":"10.3201\/eid2509.190407","article-title":"Genetic Characterization and Enhanced Surveillance of Ceftriaxone-Resistant Neisseria gonorrhoeae Strain, Alberta, Canada, 2018","volume":"25","author":"Berenger","year":"2019","journal-title":"Emerg. Infect. Dis."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"4339","DOI":"10.1128\/AAC.00504-16","article-title":"New Ceftriaxone- and Multidrug-Resistant Neisseria gonorrhoeae Strain with a Novel Mosaic penA Gene Isolated in Japan","volume":"60","author":"Nakayama","year":"2016","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_21","unstructured":"World Health Organization (2025, July 29). Gonococcal Antimicrobial Surveillance Programme (GASP). Available online: https:\/\/www.who.int\/initiatives\/gonococcal-antimicrobial-surveillance-programme."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"388","DOI":"10.14745\/ccdr.v49i09a05","article-title":"Antimicrobial susceptibilities of Neisseria gonorrhoeae in Canada, 2021","volume":"49","author":"Sawatzky","year":"2023","journal-title":"Can. Commun. Dis. Rep."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Gratrix, J., Kamruzzaman, A., Martin, I., Smyczek, P., Read, R., Bertholet, L., Naidu, P., and Singh, A.E. (2018). Surveillance for Antimicrobial Resistance in Gonorrhea: The Alberta Model, 2012\u22122016. Antibiotics, 7.","DOI":"10.3390\/antibiotics7030063"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"735","DOI":"10.3201\/eid2404.171873","article-title":"Cooperative Recognition of Internationally Disseminated Ceftriaxone-Resistant Neisseria gonorrhoeae Strain","volume":"24","author":"Lahra","year":"2018","journal-title":"Emerg. Infect. Dis."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1573","DOI":"10.3201\/eid2408.180295","article-title":"Direct Detection of penA Gene Associated with Ceftriaxone-Resistant Neisseria gonorrhoeae FC428 Strain by Using PCR","volume":"24","author":"Whiley","year":"2018","journal-title":"Emerg. Infect. Dis."},{"key":"ref_26","unstructured":"Public Health Agency of Canada (2025, July 29). Chlamydia, Gonorrhea and Infectious Syphilis in Canada: 2021 Surveillance Data Update. Available online: https:\/\/www.canada.ca\/en\/public-health\/services\/publications\/diseases-conditions\/chlamydia-gonorrhea-infectious-syphilis-2021-surveillance-data.html."},{"key":"ref_27","unstructured":"Government of Alberta (2025, July 29). Alberta Public Health Disease Management Guidelines: Gonorrhea. Available online: https:\/\/open.alberta.ca\/publications\/gonorrhea#summary."},{"key":"ref_28","unstructured":"Alberta Health, Government of Alberta (2025, July 29). Alberta Sexually Transmitted Infections and HIV 2022. Annu Rep.. Available online: https:\/\/open.alberta.ca\/publications\/9781460145449."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"129","DOI":"10.14745\/ccdr.v51i04a03","article-title":"Antimicrobial susceptibilities of Neisseria gonorrhoeae in Canada, 2022","volume":"51","author":"Sawatzky","year":"2025","journal-title":"Can. Commun. Dis. Rep."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"255","DOI":"10.15585\/mmwr.mm7312a2","article-title":"Ceftriaxone-Resistant Gonorrhea-China, 2022","volume":"73","author":"Zhu","year":"2024","journal-title":"MMWR Morb. Mortal. Wkly. Rep."},{"key":"ref_31","unstructured":"Commonwealth of Massachusetts: Bureau of Infectious Disease and Laboratory Sciences (2025, July 29). Department of Public Health Announces First Cases of Concerning Gonorrhea Strain|Mass.gov, Available online: https:\/\/www.mass.gov\/news\/department-of-public-health-announces-first-cases-of-concerning-gonorrhea-strain."},{"key":"ref_32","unstructured":"Centers for Disease Control and Prevention (2025, October 17). GISP Profiles National Data, CDC Archive. Sexually Transmitted Disease Surveillance 2022: Gonococcal Isolate Surveillance Project Profile Division of STD Prevention April 2024, Available online: https:\/\/archive.cdc.gov\/#\/details?url=https:\/\/www.cdc.gov\/sti-statistics\/media\/pdfs\/2024\/07\/2022-GISP-Profiles_National_CLEARED_CLEAN.pdf."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"dlae053","DOI":"10.1093\/jacamr\/dlae053","article-title":"High prevalence of ceftriaxone-resistant and XDR Neisseria gonorrhoeae in several cities of Cambodia, 2022\u20132023: WHO Enhanced Gonococcal Antimicrobial Surveillance Programme (EGASP)","volume":"6","author":"Ouk","year":"2024","journal-title":"JAC-Antimicrob. Resist."},{"key":"ref_34","first-page":"101125","article-title":"The WHO Enhanced Gonococcal Antimicrobial Surveillance Programme (EGASP) identifies high levels of ceftriaxone resistance across Vietnam, 2023","volume":"48","author":"Lan","year":"2024","journal-title":"Lancet Reg. Health West Pac."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"956462420949126","DOI":"10.1177\/0956462420949126","article-title":"2020 European guideline for the diagnosis and treatment of gonorrhoea in adults","volume":"ahead of print","author":"Unemo","year":"2020","journal-title":"Int. J. STD AIDS"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1177\/0956462419886775","article-title":"2018 UK national guideline for the management of infection with Neisseria gonorrhoeae","volume":"31","author":"Fifer","year":"2020","journal-title":"Int. J. STD AIDS"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1835","DOI":"10.1056\/NEJMoa1706988","article-title":"Single-Dose Zoliflodacin (ETX0914) for Treatment of Urogenital Gonorrhea","volume":"379","author":"Taylor","year":"2018","journal-title":"N. Engl. J. Med."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"2307","DOI":"10.1007\/s40121-023-00862-6","article-title":"Efficacy and Safety of Gepotidacin as Treatment of Uncomplicated Urogenital Gonorrhea (EAGLE-1): Design of a Randomized, Comparator-Controlled, Phase 3 Study","volume":"12","author":"Perry","year":"2023","journal-title":"Infect. Dis. Ther."},{"key":"ref_39","unstructured":"GSK (2025, July 29). GSK Announces Positive Headline Results from EAGLE-1 Phase III Trial for Gepotidacin in Uncomplicated Urogenital Gonorrhoea (GC)|GSK. Available online: https:\/\/www.gsk.com\/en-gb\/media\/press-releases\/gsk-announces-positive-headline-results-from-eagle-1-phase-iii-trial-for-gepotidacin-in-uncomplicated-urogenital-gonorrhoea-gc\/."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1097\/QCO.0000000000000992","article-title":"Promising developments in gonococcal vaccines","volume":"37","author":"Waltmann","year":"2024","journal-title":"Curr. Opin. Infect. Dis."},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Gulati, S., Mattsson, A.H., Schussek, S., Zheng, B., DeOliveira, R.B., Shaughnessy, J., Lewis, L.A., Rice, P.A., Comstedt, P., and Ram, S. (2023). Preclinical efficacy of a cell division protein candidate gonococcal vaccine identified by artificial intelligence. mBio, 14.","DOI":"10.1128\/mbio.02500-23"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"126709","DOI":"10.1016\/j.vaccine.2025.126709","article-title":"Adjuvant-dependent impacts on vaccine-induced humoral responses and protection in preclinical models of nasal and genital colonization by pathogenic Neisseria","volume":"48","author":"Islam","year":"2025","journal-title":"Vaccine"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"6119","DOI":"10.1128\/IAI.67.11.6119-6129.1999","article-title":"Identification of regions of the chromosome of Neisseria meningitidis and Neisseria gonorrhoeae which are specific to the pathogenic Neisseria species","volume":"67","author":"Perrin","year":"1999","journal-title":"Infect. Immun."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1603","DOI":"10.1016\/S0140-6736(17)31449-6","article-title":"Effectiveness of a group B outer membrane vesicle meningococcal vaccine against gonorrhoea in New Zealand: A retrospective case-control study","volume":"390","author":"Paynter","year":"2017","journal-title":"Lancet"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"e2331742","DOI":"10.1001\/jamanetworkopen.2023.31742","article-title":"Association of Group B Meningococcal Vaccine Receipt with Reduced Gonorrhea Incidence Among University Students","volume":"6","author":"Robison","year":"2023","journal-title":"JAMA Netw. Open"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"1021","DOI":"10.1016\/S1473-3099(21)00812-4","article-title":"Effectiveness of a serogroup B outer membrane vesicle meningococcal vaccine against gonorrhoea: A retrospective observational study","volume":"22","author":"Abara","year":"2022","journal-title":"Lancet Infect. Dis."},{"key":"ref_47","doi-asserted-by":"crossref","unstructured":"Looker, K.J., Booton, R., Begum, N., Beck, E., Shen, J., Turner, K.M.E., and Christensen, H. (2023). The potential public health impact of adolescent 4CMenB vaccination on Neisseria gonorrhoeae infection in England: A modelling study. BMC Public Health, 23.","DOI":"10.1186\/s12889-022-14670-z"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"106582","DOI":"10.1016\/j.jinf.2025.106582","article-title":"The United Kingdom meningococcal vaccine (4CMenB) programme against gonorrhoea: A review of the evidence and knowledge gaps","volume":"91","author":"Ladhani","year":"2025","journal-title":"J. Infect."},{"key":"ref_49","unstructured":"Government of Alberta (2025, July 29). Gonorrhea Test 2022, Available online: https:\/\/myhealth.alberta.ca:443\/Health\/tests-treatments\/pages\/conditions.aspx?Hwid=hw4905."},{"key":"ref_50","unstructured":"Clinical and Laboratory Standards Institute. CLSI (2025). Performance Standards for Antimicrobial Susceptibility Testing, Clinical and Laboratory Standards Institute. [35th ed.]. CLSI supplement M100."},{"key":"ref_51","unstructured":"Alberta Health and Alberta Health Services (2025, October 17). Official Standard Geographic Areas. Available online: https:\/\/open.alberta.ca\/dataset\/a14b50c9-94b2-4024-8ee5-c13fb70abb4a\/resource\/70fd0f2c-5a7c-45a3-bdaa-e1b4f4c5d9a4\/download\/official-standard-geographic-area-document.pdf."}],"container-title":["Antibiotics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2079-6382\/14\/11\/1119\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,11]],"date-time":"2025-11-11T09:30:11Z","timestamp":1762853411000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2079-6382\/14\/11\/1119"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,6]]},"references-count":51,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2025,11]]}},"alternative-id":["antibiotics14111119"],"URL":"https:\/\/doi.org\/10.3390\/antibiotics14111119","relation":{},"ISSN":["2079-6382"],"issn-type":[{"value":"2079-6382","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,6]]}}}