Background Public Health – Seattle & King County (PHSKC) participates in Strengthening the U.S. Response to Resistant Gonorrhea (SURRG), funded by the Centers for Disease Control and Prevention, to enhance surveillance of antimicrobial resistance in Neisseria gonorrhoeae (GC). We aimed to identify predictors of azithromycin-resistant GC.
Methods GC culture specimens were collected from patients with GC infection who attended the PHSKC STD Clinic or one of five King County, Washington, medical clinics during 2017–2018. Positive culture isolates underwent azithromycin susceptibility testing with Etest; azithromycin resistance (AZI-R) was defined as minimum inhibitory concentration ≥2.0 µg/mL. Clinical and sociobehavioral data was obtained from medical records and partner services interviews; we compared characteristics of cases with and without AZI-R and evaluated statistical significance with chi-square and Fisher’s exact tests.
Results During 2017–2018, 1,164 GC isolates from 1,048 unique cases underwent azithromycin Etest susceptibility testing. Overall, 6.5% of isolates and 6.8% of cases had AZI-R. Prevalence was higher in rectal isolates (8.3% of 373) than urethral (5.0% of 496, p=0.05) and similar to pharyngeal (7.4% of 270, p=0.68). AZI-R was more common in men who have sex with men (MSM) than heterosexuals (8% vs 3%, p=0.04), and in Hispanics vs. non-Hispanics (12% vs 6%, p<0.01). Age, GC history, number of sex partners, HIV-status, PrEP-status, and diagnosing facility type were not associated with AZI-R. Most (95%) AZI-R cases were treated with an azithromycin-containing regimen (dual therapy with ceftriaxone (92%) or gentamicin (4%)). Nearly all (96%) had a documented negative test of cure (culture and/or NAAT); no treatment failures were observed.
Conclusion AZI-R was identified in 6.8% of GC cases in King County, Washington. While more common in MSM and Hispanic persons, AZI-R was not strongly associated with other characteristics we evaluated. Health care providers should be aware of the potential for AZI-R in patients with GC.
Disclosure No significant relationships.
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