Antimicrobial Susceptibility Testing

Antimicrobial susceptibility testing of Neisseria gonorrhoeae. Antimicrobials on the testing panel include: azithromycin, cefixime, ceftriaxone, ciprofloxacin, penicillin, spectinomycin, and tetracycline.

• Gonorrhea

Pure culture.

Specimens may be subject to rejection if they are not the appropriate sample type, have insufficient volume, are not accompanied by relevant patient information, or not on the correct requisition.

N/A

Pure Neisseria gonorrhoeae cultures can be transported in: i) Amies Clear Agar Gel Transport Swabs; ii) Chocolate Agar Slants that have been incubated at 35oC in a CO2 enriched atmosphere for 18-24 hours before transport; iii) BHI (Brain Heart Infusion) broth containing 20% glycerine, frozen at -80oC, shipped on dry ice.  Cultures MUST be shipped before the Wednesday of each week.

Shipping of specimens shall be done by a TDG certified individual in accordance with TDG regulations. For additional information regarding classification of specimens for the purposes of shipping, consult either Part 2 Appendix 3 of the TDG Regulations or section 3.6.2 of the IATA Dangerous Goods Regulations as applicable.

Infection with N. gonorrhoeae.

Completed Gonococcal Antimicrobial Surveillance Program (GASP) – Canada requisition form with sender lab name, address, telephone number and email address.  All patient information must be filled out including patient identifier (specimen reference #), date of birth and sex, type of specimen submitted, date collected, isolation site and test requested.  Test results to be included, if possible, are antimicrobial susceptibility values and beta-lactamase results.  Submit one GC culture per case unless related to a treatment failure investigation. Urgent specimens or those requiring agar dilution testing must be noted as such on the requisition.

This test is done as part of the Gonococcal Antimicrobial Surveillance Program – Canada (GASP - Canada) testing algorithm. 

Prediction of antimicrobial susceptibilities using whole genome sequencing (primary) (8)

Antimicrobial susceptibility testing using agar dilution (secondary) (2) 

180 calendar days

Outbreak associated or urgent isolates will be granted priority status and completed as soon as possible. Please contact Streptococcus and STI Section to notify of these requests.

**Turnaround times may not be guaranteed when isolates are submitted in large batches.

1. Brown LB, Krysiak R, Kamanga G, Mapanje C, Kanyamula H, Banda B, Mhango C, Hoffman M, Kamwendo D, Hobbs M, Hosseinipour M, Martinson F, Cohen MS, Hoffman IF.  Neisseria gonorrhoeae antimicrobial susceptibility in Lilongwe, Malawi, 2007.  Sex Transm Dis 2010;37:169-172
2. CLSI. Performance Standards for Antimicrobial Susceptibility Testing. 29th ed. CLSI supplement M100. Wayne, PA: Clinical and Laboratory Standards Institute; 2019.
3. Ehret JM, Nims LJ, Judson FN.  A clinical isolate of Neisseria gonorrhoeae with in vitro resistance to erythromycin and decreased susceptibility to azithromycin. Sex Transm Dis 1996;23:270-272.
4. Daly CC, Hoffman I, Hobbs M, Maida M, Zimba D, Davis R, Mughogho G, Cohen MS. Development of an antimicrobial susceptibility surveillance system for Neisseria gonorrhoeae in Malawi:  Comparison of methods. J Clin Micro 1997;35:2985-2988.
5. Laboratory Protocols for Testing N. gonorrhoeae - Preparation of Antimicrobial Containing Media to Determine Susceptibility of Neisseria gonorrhoeae (Agar Dilution Method) - October 1996 (edited and prepared by M. Pauzé, Bureau of Microbiology)
6. Unemo M, Fasth O, Fredlund H, Limnios A, Tapsall J.  Phenotypic and genetic characterization of the 2008 WHO Neisseria gonorrhoeae reference strain panel intended for global quality assurance and quality control of gonococcal antimicrobial resistance surveillance for public health purposes.  J Antimicrob Chemother 2009;63:1142-1151.
7. World Health Organization (WHO).  Global action plan to control the spread and impact of antimicrobial resistance in Neisseria gonorrhoeae. 2012. Available from: http://www.who.int/reproductivehealth/publications/rtis/9789241503501/en/.  Accessed 22 May 2012.
8. Demczuk W, Martin I, Sawatzky P, Allen V, Lefebvre B, Hoang L, Naidu P, Minion J, VanCaeseele P, Haldane D, Eyre DW, Mulvey MR. Equations to predict antmicrobial MICs in Neisseria gonorrhoeae using molecular antimicrobial resistance determinants. AAC 2020;64:e02005-19 https://doi.or/10.1128/AAC02005-19

Pathogen Safety Data Sheets: Infectious Substances – Neisseria gonorrhoeae

National case definition: Gonorrhea

Canadian Guidelines on Sexually Transmitted Infections

Gonorrhea