Strengthening the US Response to Resistant Gonorrhea: An Overview of a Multisite Program to Enhance Local Response Capacity for Antibiotic-Resistant Neisseria gonorrhoeae

Abstract

Background: In 2016, Centers for Disease Control and Prevention initiated Strengthening the US Response to Resistant Gonorrhea (SURRG) in multiple jurisdictions to enhance antibiotic resistant gonorrhea rapid detection and response infrastructure and evaluate the impact of key strategies.Methods: Eight jurisdictions were funded to establish or enhance local gonococcal culture specimen collection in sexually transmitted disease and community clinics, conduct rapid antimicrobial susceptibility testing (AST) in local laboratories, modify systems for enhanced data collection and rapid communication of results, and initiate enhanced partner services among patients with gonorrhea demonstrating elevated minimum inhibitory concentrations (MICs) to ceftriaxone, cefixime or azithromycin.Results: Grantees incorporated genital, pharyngeal, and rectal gonococcal culture collection from all genders at participating clinics. During 2018 to 2019, grantees collected 58,441 culture specimens from 46,822 patients and performed AST on 10,814 isolates (representing 6.8% [3412] and 8.9% [4883] of local reported cases in 2018 and 2019, respectively). Of isolates that underwent AST, 11% demonstrated elevated azithromycin MICs; fewer than 0.5% demonstrated elevated ceftriaxone or cefixime MICs. Among patients whose infections demonstrated elevated MICs, 81.7% were interviewed for partner elicitation; however, limited new cases were identified among partners and contacts.

Impact of Anatomic Site, Specimen Collection Timing, and Patient Symptom Status on Neisseria gonorrhoeae Culture Recovery

“…However, culture is still required to assess antimicrobial resistance (AMR) in gonorrhea treatment failure cases and AMR surveillance programs such as the Centers for Disease Control and Prevention's (CDC) Gonococcal Isolate Surveillance Project 7 and Strengthening the US Response to Resistant Gonorrhea (SURRG). 8 For clinics and laboratories that continue to culture N. gonorrhoeae, many variables influence culture success. From the clinical perspective, the anatomic site of infection impacts N. gonorrhoeae culture recovery, with reduced culture sensitivity from endocervical 9,10 and extragenital infections.…”

Exploring and Comparing the Structure of Sexual Networks Affected by Neisseria gonorrhoeae Using Sexual Partner Services Investigation and Genomic Data

“…The Gonococcal Isolate Surveillance Project has monitored antimicrobial susceptibility trends among men with symptomatic gonococcal urethritis in the United States since 1986, 2 whereas SURRG was established in 2016 and supports a range of activities in local jurisdictions to enhance capacity for rapid detection of and response to antibiotic-resistant gonorrhea. 12 For SURRG, jurisdictions conducted partner services investigations for people diagnosed with NG with elevated minimum inhibitory concentrations (MICs) to azithromycin (≥2 μg/mL), ceftriaxone (≥0.125 μg/mL), or cefixime (≥0.25 μg/mL) and performed WGS on these isolates.…”

“…Full details of SURRG methodology are described elsewhere. 12 Partner Services Investigation Networks Partner services investigations were initiated for people diagnosed with an NG infection that had elevated MICs to azithromycin (≥2 μg/mL), ceftriaxone (≥0.125 μg/mL), or cefixime (≥0.25 μg/mL; hereafter referred to as "index cases"). Sexual partners within the last 2 to 3 months (based on local protocols) and, as part of enhanced investigations for SURRG, social contacts (nonsexual contacts the patient thought might benefit from STI testing) were attempted to be contacted and referred for testing.…”

“…As part of enhanced investigations for SURRG, regardless of the sexual partner's NG status, their partners (i.e., partners of partners) were also contacted and referred for testing. Investigations continued until 2 generations of sexual partners of an index case tested negative for gonorrhea 12,13 (Supplementary Material Fig. S1, http://links.…”

Test of Cure Return Rate and Test Positivity, Strengthening the US Response to Resistant Gonorrhea, United States, 2018–2019

“…Additional data on collected specimens, isolates, and overall patient populations in SURRG are reported elsewhere. 13 Comparison of Patients Who Did and Did Not Return for a TOC Visit Among patients with RS gonorrhea, 59% (690 of 1165) returned for a TOC visit, with a wide variability in TOC visit return rates by jurisdiction, ranging from 32% (9 of 28) in Honolulu to 80% (101 of 126) in Denver (Table 1). The weighted overall TOC return rate was 61% (95% confidence interval, 50.1%-72.6%), and unweighted return rates were steady over time (Figure S1, http://links.lww.com/ OLQ/A740).…”