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Background: Recent reports have documented reduced susceptibility of Neisseria gonorrhoeae to cephalosporins; currently there are few alternative treatments available. As with other drug-resistant gonorrhea, California may be among the first areas to encounter cephalosporin-resistant Neisseria gonorrhoeae (CRNG). Therefore, it is imperative that strategies are employed statewide to prevent, detect, and rapidly respond to CRNG.
Objectives: A multi-disciplinary workgroup identified the following objectives: (1) increase the use of optimal treatment; (2) expand access to screening, especially rectal and pharyngeal screening in men who have sex with men; (3) ensure laboratory capacity for culture and antibiotic susceptibility testing; (4) identify isolates with reduced susceptibility and cases of suspected treatment failure; (5) rapidly investigate and intervene in ongoing transmission; and (6) raise awareness among policy makers and those in at-risk communities.
Project Description: General approaches to meeting objectives include engaging public health, clinical, and laboratory stakeholders and providing training and technical assistance in high priority settings. To allow for a rapid response to alert values, San Francisco Public Health Laboratory has conducted antimicrobial susceptibility testing of all GISP isolates statewide, in addition to rectal and pharyngeal specimens from select GISP sites.
Findings: From January to June 2011, 49.9% of gonorrhea cases were treated with sub-optimal antibiotic regimens. Of 124 California laboratories that perform nucleic acid amplification testing for gonorrhea, only 17 percent test rectal/pharyngeal specimens. Although 188 labs perform gonorrhea culture, only 23 percent test for antibiotic susceptibility. Rapid susceptibility testing identified 23 isolates with alert values; 35 percent were ceftriaxone alerts.
Conclusions: A collaborative and multifaceted strategy is best suited for achieving the multiple, interconnected objectives designed to delay the emergence and interrupt the spread of CRNG.
Implications for Programs, Policy, and Research: Coordinated national-state efforts are critical for responding to this new threat. Key needs include (1) extra-genital testing capacity; (2) alternatives to traditional culture and susceptibility testing; and (3) expanded and more rapid surveillance strategies.