Risk factors of multidrug-resistant gonococcal infections: an analysis of data from the sentinel surveillance network- Québec, Canada, 2017–2019

The emergence of antimicrobial resistance (AMR) in Neisseria gonorrhoeae is a worrying global phenomenon, with major implications for public health. This study, a cross-sectional analysis of an open cohort, explored the risk factors associated with multidrug-resistant (MDR) gonococcal infections in the province of Québec, Canada, using data from the sentinel surveillance network from 2017 to 2019. The data comprised sociodemographic, epidemiological, and clinical information, collected through self-administered questionnaires, direct case interviews and chart reviews coupled with laboratory AMR data for five antibiotics: azithromycin, tetracycline, ciprofloxacin, cefixime, and ceftriaxone. Missing data were handled using multiple imputation with chain equations (MICE); generalized estimating equations (GEE) were used to assess correlates of MDR. The analysis included 714 participants with a total of 775 cases. We observed very frequent resistance to ciprofloxacin (74.3%), while resistance to tetracycline and azithromycin was 19.9% and 21.3%, respectively. MDR was found in 12.5% of cases. Multivariate analysis indicated that having five or more sexual partners in the past two months (aPR=1.61, 95%CI: 1.07-2.41) was associated with MDR. In conclusion, our results show an association between the number of sexual partners and MDR, supporting the hypothesis that resistance can develop more rapidly in dense sexual networks. It is crucial to address the issue of circulating resistant strains through ongoing surveillance, research, and targeted interventions to manage and contain them before they become widespread.