Background: The Gonoccocal Isolate Surveillance Project (GISP) is a national program to monitor trends in antimicrobial susceptibility of N. gonorrhoeae. Data from GISP is used to inform national gonorrhea treatment recommendations by the Centers for Disease Control and Prevention. However, GISP represents less than 5% of all reported U.S. gonorrhea cases, and little is known about how well patients whose specimens are submitted to GISP represent all urogenital male disease.
Methods: Specimens from the first 25 male patients with symptomatic urogenital gonorrhea seen at San Francisco City Clinic (SFCC) each month are submitted to GISP. Using data in the STD surveillance database from 2009-2012, we compared demographic characteristics among men with specimens submitted to GISP to two other groups of men diagnosed with urogenital gonorrhea: other men diagnosed at SFCC, and men diagnosed by other providers and reported to the San Francisco Department of Public Health (SFDPH). Chi-square tests were used to compare groups.
Results: During the time period, 2,900 urogenital cases of gonorrhea were reported to SFDPH; of these, 763 (26.3%) were submitted to GISP. Of the 2137 cases not submitted to GISP, 257 (8.9% of total cases) were diagnosed at SFCC and 1880 (64.8% of total cases) were reported from other providers. The age distribution of cases was similar across all three groups (p=0.63). Patients diagnosed by outside providers were less likely to be Black (p<0.0001) and less likely to be men who have sex with men (p<0.0001) compared with patients whose specimens were submitted to GISP or diagnosed at SFCC.
Conclusions: While patients whose specimens were submitted to GISP were similar to other patients with urogenital gonorrhea at SFCC, the comparability to patients with urogenital gonorrhea citywide is limited. Given the importance of monitoring for gonococcal antibiotic resistance in the United States, surveillance platforms beyond GISP may be required.