Some people have pain or burning, others have no symptoms at all.

It's that lack of symptoms — and consequently, a lack of testing — the deputy chief public health officer for the Northwest Territories, Kami Kandola, says could be behind what she calls a "dramatic increase" in gonorrhea infection rates between 2013 and 2016.

Kami Kandola, deputy chief public health officer for the N.W.T., has noted a 'dramatic increase' in gonorrhea infection rates between 2013 and 2016. New statistics from 2016 show the sexually transmitted infection affects 18 times more people in the N.W.T. than in the rest of Canada. Across the country, there are about 0.6 cases per 1,000 people. In the Northwest Territories, the number is closer to 11 per 1,000 people.

"There could be a whole host of reasons for that," says Kandola."If people are engaging in oral or anal intercourse and not getting tested, they can spread it to others, because they may think only unprotected vaginal intercourse may put [them] at higher risk."

In fact, Kandola says gonorrhea can also appear in the throat and anus, where people may not think to get tested, or see themselves as at risk.

Symptoms generally include discharge, itching, and pain or burning when urinating. In women, it can lead to abdominal pain, pelvic inflammatory disease and ectopic pregnancy.

Kandola says infection rates in the N.W.T. have been climbing since 2013, when there were fewer than 3 cases per 1,000 people in the territory.

She says rates are higher in the smaller communities, and in young adults — women between 15 and 24 years of age, and men from 20 to 29.

"We need to be testing more, and we need to be spreading the message about using condoms, not only for vaginal intercourse, but for oral and rectal as well."

No superbugs... yet

Kandola says in addition to regular testing to catch the infection before it spreads, the Health department is working to ensure northern strains do not become drug-resistant.

The Northwest Territories has launched a surveillance program to test cultures of gonorrhea for drug resistance.

Kandola says safe sex, including the use of condoms, is one of the best ways to prevent the spread of gonorrhea. (Kate McGillivray/CBC) So far, Kandola says, there's no sign of these 'superbugs.'"But ... we are a territory where a lot of people travel," she says. "So if they go into an area where there's a multidrug-resistant strain, or a strain where there's no current treatment available, it's just a plane ride away to coming back to the Northwest Territories and transmitting it here."

Signs of improvement

It's still too early to tell for sure, but Kandola says there are already some positive signs rates may be on the downswing.

"When we are looking at the 2017 data, our preliminary data, the rates seem to be coming down for some of the communities," she says. "So there seems to be a turn."

Kandola says she'll know whether the rates are improving by the end of the year.