Gonorrhea (GC) has been identified as an urgent antimicrobial resistance threat, yet its prevalence is not well characterized in all risk groups. We evaluated the prevalence of GC resistance and associated factors in a population of at-risk U.S. DoD beneficiaries.
Patients from 5 U.S. military treatment clinics where STIs are diagnosed were recruited to provide either a urethral, endocervical, or urine sample (depending on standard of care) for culture and a confidential, self-administered questionnaire. Jembec plates inoculated with first-catch urine, InTray plates (urethral swabs) or cervical swabs were incubated under 5% CO2 at 35 C for 72 hours and were examined for growth before being called negative. Oxidase-positive, superoxol-positive Gram-negative diplococci were confirmed as N. gonorrhoeae using the NH API and Phadebact tests. The minimal inhibitory concentration of eight antibiotics against each isolate was determined using the E-test. Susceptibility levels were defined as per CSLI guidelines.
253 participants (73% male, 31% white, 48% black, 10.3 % Hispanic, 89% active duty) were enrolled between 8/2013-2/2016. 18% were married, 41% deployed at least once, 21% reported an STI diagnosis in the last year. 33% reported concurrent sexual partners and at last sexual encounter, 70% was with a civilian partner, 41% with a casual/one night stand partner, 29% met on the internet, and 66% did not use a condom. 90 plates (35.7%) had growth and of those, 29 (11.5%) tested positive for GC. Of those, 25 (82.8%) had either resistant of decreased susceptibility profiles. 1 (3%) had ciprofloxacin resistance with decreased susceptibility to penicillin, tetracycline, and cefixime and 7/29 (24%) were ciprofloxacin resistant with decreased susceptibility penicillin and tetracycline. Decreased susceptibility to penicillin and tetracycline for 8 (28%), 7 (24%) penicillin only, and 1 (3%) tetracycline only.
Resistant and/or decreased susceptibility were found among 82.8% of our GC positive cases for antibiotics not currently used and are similar to reports from other populations. Current efforts include sequencing of resistance determinants and to identify if resistance patterns can be identified (e.g., MIC ranges, clusters from a particular clinical site, etc.).
N. Rahman, None
M. Byrne, None
J. Sanchez, None
C. Berry-Caban, None
R. Marcum, None
T. Roberts, None
R. Deiss, None
T. Lalani, None
A. Jerse, None
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