Targeting Culture Criteria to Maximize Culture Positivity of Neisseria gonorrhoeae in 3 Sexual Health Clinic Settings

Abstract

Background: Although most gonorrhea (GC) cases in the United States are detected using nucleic acid amplification tests (NAATs), isolation of Neisseria gonorrhoeae (NG) using culture specimens is needed for antibiotic susceptibility testing (AST). We present data on NAATs and cultures collected before and during the Centers for Disease Control and Prevention demonstration project (Strengthening the US Response to Resistant Gonorrhea [SURRG]) to describe a process to define culture criteria for NG isolation for surveillance of NG with reduced susceptibility.Methods: For sexually transmitted infection clinics in New York City, NY; San Francisco, CA; and Milwaukee, WI, we calculated NAAT positivity by anatomic site in 2016 (pre-SURRG) across 3 groups: (1) sex partners of persons with GC, (2) patients with symptoms (e.g., urethral or cervical discharge), (3) patients who had tested positive and were returning for GC treatment and compared it with positivity among all other patients. We then examined SURRGperiod NAAT positivity among patients from whom a culture was or was not collected, and culture positivity, by specimen site and jurisdiction.Results: Pre-SURRG, NAAT positivity across the 3 select groups was at least twice that of patients who did not meet any criteria. SURRG-period NAAT positivity was higher among patients from whom a culture was also collected. Overall culture positivity was relatively high (New York City, 34.8%; San Francisco, 26.7%; Milwaukee, 24.8%); the proportion of specimens tested varied widely (range, 5.7%-26.5%) by jurisdiction.

New Evidence for Antimicrobial-Resistant Gonorrhea Control Programs: Lessons Learned from the SURRG Project

“…Using NAAT data from 3 SURRG sites (Milwaukee, New York, and San Francisco), Nguyen et al 17 analyzed different criteria for obtaining specimens for culture to help predict those that will maximize yield. They compared individuals who were a contact to gonorrhea, had symptoms of a GC syndrome, or were returning for the treatment of gonorrhea with those who did not meet those criteria.…”