Introduction Gonorrhoea (GC) has been identified as an urgent antimicrobial resistance treat, yet its prevalence is not well characterised in all risk groups. We were interested in establishing an ongoing surveillance effort to identify the prevalence of GC resistance and associated factors in at-risk U.S. DoD benefiaries.

Methods We identified DoD military treatment facilities (MTFs) where sexually tranmitted infections are diagnosed that had both high rates of GC and a local champion. Upon assessment, culture testing capacity was low and not standard of care. The study protocol required a sample for culture and a confidential, self-administered questionnaire. Standard processes for GC collection, culture, sensitivity testing were implemented.

Results Six MTF clinics were included with geographic representation (Colorado, California (CA), North Carolina, Texas, Virginia, Washington) and project expanded to include a GC reference laboratory and respository. Study participants (n=253): 73% male, 31% white, 48% black, 18% married, 21% had STI diagnosis within the last year. At last sexual encounter, 70% was with a civilian partner, 29% met on the internet, and 66% did not use a condom. 90 plates had growth, 29 tested positive for GC. Sensitivity of GC culture testing from urine was 66%, 82.8% of isolates had resistant or decreased susceptibility profiles. Reduced susceptibility to Cefixime and Azithromycin was indentified in CA. Ceftriaxone MICs remain within susceptible ranges, but the have begun to rise. Slightly elevated MICs to Ceftriaxone have been identified at Navy sites. 3/5 (60%) of these isolates also have reduced susceptibility to Azithromycin. 10 new NG-Multi Antigen Sequence Typing types were identified.

Conclusion We successfully established a U.S. DoD GC resistance surveillance and repository. Urine culture testing for GC may be acceptable for identifying population level resistance. While U.S. dual therapy is currently effective, the slow rise in MICs highlights the need for novel therapeutics and continued surveillance.