NEVER SEEN SINCE 2020: TWO ANTIBIOTIC-RESISTANT STRAINS OF GONORRHEA IN MONTREAL
Rapid increase of gonorrhea in Montreal
Gonorrhea is experiencing a rapid increase in Montreal. In 2024, the Regional Public Health Department (DRSP) recorded 5,458 cases of gonococcal infection, a record number in 25 years. This represents an incidence rate of 257.3 cases per 100,000 person-years, a level never seen in the city.
While men remain the most affected, with 4,453 cases (419.3 per 100,000), the situation is evolving rapidly among women, now accounting for 924 cases (85.9 per 100,000). Between 2020 and 2024, incidence increased by 112% among women, compared to 63% among men, a trend reversal that concerns health authorities.
Sexually transmitted infection spreading in Montreal
Gonorrhea, a sexually transmitted infection (STI) caused by the bacterium Neisseria gonorrhoeae, often goes unnoticed, but its consequences can be serious. Untreated, it causes chronic pain, reproductive organ infections, reduced fertility, and, more rarely, disseminated infection affecting joints or the heart. It also increases susceptibility to HIV and can be transmitted from mother to child during childbirth, sometimes causing severe complications in newborns.
Antibiotic-resistant strains detected in Montreal
The increase in cases is compounded by the growing antibiotic resistance of gonorrhea. In 2024, two strains resistant to third-generation cephalosporins (ceftriaxone or cefixime) were detected in the region, while none had been reported since 2020. This highlights the importance of constant microbiological monitoring and culture-based screening to detect resistance and adjust treatments.
Changing infection profile
Gonorrhea now primarily affects sexually active adults, not just teenagers. About 82% of cases concern men, but the rapid increase among women aged 25–34 is notable. The most frequent infection sites are the throat (41%), urethra (25%), and rectum (25%), emphasizing the need for site-specific STI screening during oral, anal, or vaginal sexual activity.
Over half of women (56%) and more than a third of men (36%) diagnosed in 2024 had no prior STI history, showing that gonorrhea can affect any sexually active person, even without apparent risk factors.
Prevention and screening: key strategies against gonorrhea
Health authorities emphasize safe sexual practices and regular STI screening, particularly for individuals with multiple partners. Condoms remain the primary prevention tool, as there is no vaccine against gonorrhea.
Recommended screening frequency
Experts advise annual STI testing for people under 30, and every 3–6 months for those with multiple partners. Following a positive diagnosis, patients should abstain from sexual activity for at least 7 days, perform a follow-up test 3 weeks later, and inform sexual partners from the past 60 days so they can be tested.
Additional prevention measures
Complementary strategies such as PrEP (pre-exposure prophylaxis for HIV), Doxycycline post-exposure (Doxy-PEP), or vaccination against HPV, hepatitis A and B, and mpox can also help reduce infection risk.
In the context of rising antibiotic resistance, the DRSP urges collective action to curb the spread of gonorrhea and preserve the effectiveness of treatments.
Risk of death from antibiotic-resistant gonorrhea
There is a real, though rare, risk of death from antibiotic-resistant gonorrhea, especially when the infection is untreated or unresponsive to standard therapy.
Deadly potential of resistant gonorrhea
Gonorrhea, caused by Neisseria gonorrhoeae, primarily infects genital, anal, and oral mucous membranes. When treated promptly with the correct antibiotics, it resolves without complications. The major concern today is the emergence of multi-drug resistant strains, especially to third-generation cephalosporins (e.g., ceftriaxone), the last line of defense.
Resistant infections can persist and spread, and in severe cases, bacteria may enter the bloodstream causing disseminated gonococcal infection (DGI). This rare but serious condition can lead to:
- Septicemia (bloodstream infection),
- Purulent arthritis (joint infection),
- Endocarditis (heart infection),
- Meningitis (brain and meninges infection).
If untreated or if antibiotics fail, these complications can lead to death.
WHO recognizes the risk
The threat lies less in “classic” gonorrhea than in its growing untreatable potential due to resistance. The World Health Organization (WHO) considers gonorrhea an urgent global threat, warning that some strains could become fully resistant to all known treatments.
Death from gonorrhea is exceptional, but the risk rises with bacterial resistance. This underscores the importance of early detection, appropriate treatment, and medical follow-up to prevent the spread of resistant strains.
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