Hastings Prince Edward Public Health
Online Bulletin for Health Care Providers

April 20, 2023

From:
Dr. Ethan Toumishey
Medical Officer of Health and CEO
Hastings Prince Edward Public Health

In this Issue:

1. MDR Neeisseria gonorrhea
2. New HIV testing guidelines
3. Online prenatal classes  
4. Healthy Families updates

News & Updates

MDR Neeisseria gonorrhea

A case of Neisseria gonorrhea has been identified in an Ontario patient that has a similar resistance pattern to the Multidrug Resistance Strain (MDR) of Neisseria gonorrhea identified in the United States and Europe.

What is MDR Neisseria gonorrhea?

MDR Neisseria gonorrhea has decreased susceptibility/resistance to one currently recommended therapy (cephalosporin or azithromycin), as well as resistance to at least two other antimicrobials (penicillin, tetracycline, erythromycin, ciprofloxacin).*

*Multidrug-resistant and extensively drug-resistant gonorrhea in Canada, 2012–2016

How does MDR Neisseria gonorrhea impact how we test for sexually transmitted infections?

For all patients suspected of having gonorrhea (based on symptoms or a named contact of gonorrhea); collect both N. Gonorrhea Culture as well as NAAT testing from all potentially exposed sites (including oral, rectal and urethra/cervical). Both tests are recommended given that NAAT testing is more sensitive and culture allows for assessment of drug sensitivity.

Neisseria gonorrhea testing instructions, kit ordering and specimen storage/transportation information can be found on the Public Health Ontario website.

How does this impact Neisseria gonorrhea case follow-up?

If you identify any patients with MDR Neisseria gonorrhea, please contact Hastings Prince Edward Public Health at 613-966-5500, ext. 418 regarding case management and to support notification and follow-up of contacts.

If you have patients who have non-MDR Neisseria gonorrhea, continue to treat based on the Ontario Gonorrhea Testing and Treatment Guide; 2^nd Edition.

• Recommended first line therapy: Ceftriaxone 250 mg intramuscularly (IM) plus azithromycin 1g orally (PO)
• Alternative therapeutic options are only to be considered if first-line therapy is not possible AND MUST be followed by a test of cure.

Test of Cure (TOC) is recommended for ALL positive cases of Neisseria gonorrhea at ALL positive sites. Culture is the preferred method of TOC and should be performed three to seven days after treatment. If culture is not available; test of cure by NAAT testing will also be accepted two to three weeks post treatment. https://www.canada.ca/en/public-health/services/infectious-diseases/sexual-health-sexually-transmitted-infections/canadian-guidelines/gonorrhea.html

Reminder: Publicly funded STI medications can be ordered through Hastings Prince Edward Public Health:

• Online order form
• Printable pdf order form

All persons with N. gonorrhea infection should be rescreened at six months or at first follow-up appointment within 12 months.

What can we do to help decrease the spread of MDR Neisseria gonorrhea?

Talk to your patients about sexually transmitted infections. Encourage prevention including condom use and routine testing for all people that have unprotected sex. Ensure sexually transmitted infection testing includes all sites potentially exposed including oral, rectal and urethral/cervical.

New HIV testing guidelines

The Ontario Guidelines for Providers Offering HIV Testing (2023) represents a progressive step forward in efforts toward the elimination of new HIV infections in Ontario.

The new HIV testing guidelines recommend:

• Streamlined testing and counselling for people at risk of HIV infection
• Stronger focus on identifying symptoms of acute and chronic HIV
• Routine testing for members of populations with higher rates of HIV
• Supporting equitable access to prevention strategies for people at risk of HIV infection (e.g., HIV Pre-Exposure Prophylaxis (PrEP) and HIV Post Exposure Prophylaxis (PEP)) and access to culturally relevant services and treatment for people with HIV infection
• Reducing the current window for definitively diagnosing HIV from three months to six weeks, to reflect advances in testing technologies.

For more information and a helpful one-page algorithm summarizing Ontario’s testing recommendations, please visit www.hivtestingontario.ca

Reminder: we still offer free online prenatal classes

HPEPH continues to offer four free online prenatal eClasses. These include classes on pregnancy, birth, breastfeeding, and newborn care. The instructions to access the classes are found here.

Questions? A public health nurse will be available to answer any questions about our eClasses by email or telephone via the CARELine Monday to Friday from 8:30 a.m. to 4:30 p.m.

Telephone: 613-966-5500, ext. 223
Email: careline@hpeph.ca

Healthy Families website updates

We have recently made significant revisions to our Partners and Professionals section of the HPEPH website with the goal of making it easier for you to learn about our programs and make a referral. Instead of separate headings for Child Health, Infant Feeding and Breastfeeding and Preconception and Pregnancy, you will now find this information under the single heading: Healthy Families. The Healthy Families tab conveniently includes not only information for all Healthy Families programs, you can also find our universal referral form, promotional material downloads and a list of resources for practitioners. View the new Healthy Families page at hpePublicHealth.ca/healthy-families-hcp/.

Back to Summary

Contact Information: 

To report communicable diseases:613-966-5500 x349

To report AEFI or DOPHS: Online / Fax: 613-966-1813 or CDCFAX1@hpeph.ca

Hastings Prince Edward Public Health is situated and provides services on the traditional territory of the Anishinaabe, Huron-Wendat and Haudenosaunee people.

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