Background:
The Gonococcal Isolate Surveillance Project (GISP), which monitors antibiotic resistance in the US, established Los Angeles (LA) as a sentinel site in 2003. Two sites were selected based on the volume of STD testing done and the diversity of the populations they serve.

Objective:
Describe the two year resistance trends and characterize the factors associated with resistant gonorrhea cases identified through the LA GISP

Method:
In 2003, urethral cultures were collected from consecutive symptomatic males. The clinics also collected demographic, clinical, and behavioral data. Positive isolates presumptively identified were shipped to a Regional Laboratory for confirmation and antibiotic susceptibility testing.

Result:
The percent of isolates with resistance to penicillin, tetracycline, and ciprofloxacin had decreased from 18%, 23%, and 12%, in 2003, to 3%, 13%, and 9%, in 2005. Decreased susceptibility to azithromycin had increased from 0.38% in 2004 to 3% in the first half of 2005. Decreased susceptibility to cefixime was seen is 0.75% of isolates in 2004 but was not seen in 2005. Among GISP participants, 46% were 20-29, 70% were heterosexual, 4% were HIV positive, and 71% were African American. In multivariate analysis, age (adjusted odds ratio (aOR) 2.56, 95% confidence interval (CI) 1.43, 4.58) and sexual orientation (aOR 2.85, CI 1.44, 5.64) were found to be associated with resistant gonorrhea infection.

Conclusion:
GISP surveillance in Los Angeles suggests that decreased susceptibility to azithromycin has increased while resistance to penicillin, tetracycline, and ciprofloxacin has decreased. Findings also indicate that age and sexual orientation are associated with resistant gonorrhea infection in this population.

Implications:
Continued epidemiological surveillance of drug resistant gonorrhea is indicated to help guide treatment recommendations.