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Neisseria gonorrhoeae Multiantigen Sequence Typing Is Beneficial in Further Characterizing Gonococcal Populations in Alberta, Canada

Singh, Ameeta E. BMBS, MSc*; Gratrix, Jennifer RN, MSc; Read, Ron MD; Lovgren, Marguerite MLT, ART§; Drews, Steven J. PhD; Romanowski, Barbara MD; Sutherland, Karen RN, MA; Talbot, James MD, PhD**; Martin, Irene BSc††

doi: 10.1097/01.olq.0000431356.80840.d4
Original Study

Background Antimicrobial resistance testing and behavioral data combined with Neisseria gonorrhoeae multiantigen sequence typing (NG-MAST) can help to define gonococcal populations and identify, characterize, and compare clusters of infection.

Methods Antimicrobial resistance testing, using E test, was reviewed for gonococcal isolates in Alberta, Canada, from 2007 to 2011. Antimicrobial resistance testing was conducted on isolates demonstrating antimicrobial resistance and those with cefixime minimum inhibitory concentrations (MICs) of 0.06 μg/mL or greater. Demographic and behavioral information was obtained from provincial surveillance data. NG-MAST typing was conducted on a proportion of isolates.

Results Gonococcal isolates were available for 2250 (26.4%) of 8535 cases of gonorrhea in Alberta from 2007 to 2011. The proportion of cases with decreased susceptibility to cefixime (≥0.06 μg/mL) increased from 0.7% to 2.4% between 2007 and 2009 to a high of 10.1% in 2010 and 8.9% in 2011. Six isolates with cefixime MIC of 0.25 μg/mL were noted: 5 were from men who have sex with men (MSM) and 1 was a pharyngeal isolate from a heterosexual female. Twenty-four (1.1%) isolates were azithromycin resistant (MIC ≥2.0 μg/mL); there were no significant differences between cases resistant or susceptible to azithromycin. NG-MAST of gonococcal isolates in Alberta suggests the entry of multiple strains into the province. Three clusters were identified: Cluster A predominantly in MSM, including sequence type 1407, a ST previously associated with decreased susceptibility to expanded spectrum cephalosporins; Cluster B, a predominantly heterosexual cluster with most cases in Edmonton; and Cluster C among MSM.

Conclusions Our data highlight the use of NG-MAST in further defining gonococcal populations.

Neisseria gonorrhoeae multiantigen sequence typing in gonococcal cases in Alberta, Canada, enhanced standard epidemiologic surveillance and showed significant strain diversity.

From the *Edmonton STI Clinic and †STI Services, Alberta Health Services, Edmonton, Alberta, Canada; ‡Calgary STI Clinic, Alberta Health Services, Calgary, Alberta, Canada; §Provincial Laboratory for Public Health, Edmonton, Alberta, Canada; ¶Provincial Laboratory for Public Health, Calgary, Alberta, Canada; ∥University of Alberta, Edmonton, Alberta, Canada; **Alberta Health, Edmonton, Alberta, Canada; and ††National Microbiology Laboratory, Winnipeg, Manitoba, Canada

Acknowledgments: The authors wish to acknowledge manuscript review by other members of the Alberta Gonorrhea Antimicrobial Surveillance Working Group: J. Bergman, D. Gregson, C. Egan, K. Simmonds, and K. Zhang.

The authors have declared no conflict of interest; this work was unfunded.

Correspondence: Ameeta Singh, BMBS, MSc, University of Alberta, 3B20-11111 Jasper Ave, Edmonton AB. T5K 0L4, Canada 3B20-11111. E-mail:

Received for publication February 12, 2013, and accepted May 14, 2013.

© Copyright 2013 American Sexually Transmitted Diseases Association