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Background: Neisseria gonorrhoeae (NG) isolates from NYC STD clinic patients are tested for azithromycin (AZ) susceptibility using e-test. Isolates with minimum inhibitory concentration (MIC) > 2ug/ml are considered to have reduced susceptibility. At 2 NYC STD clinics, men-who-have-sex-with-men (MSM) with laboratory-confirmed NG are asked to return for test-of-cure (TOC) 7 days after treatment.
Methods: Reviewing electronic medical record data, we identified case-patients with positive NG culture following treatment with AZ alone. Demographic, sexual behavior, anatomic site of specimen collection, and NG laboratory testing data were extracted.
Results: Case A: 28 year old white non-Hispanic HIV-negative MSM presumptively treated with AZ/2 grams, had culture-confirmed urethral NG infection (AZ MIC =3 ug/ml); he returned 14 days later with symptom recrudescence, and reported one interim male sex partner. NG urine nucleic acid amplification test (NAAT) was positive, urethral culture not done; oropharyngeal culture was positive (AZ MIC >256 ug/ml). Case B: 31 year old white non-Hispanic HIV-negative MSM presumptively treated with AZ/2 grams, had culture-confirmed urethral NG infection (AZ MIC = 1 ug/ml), returned for routine TOC 14 days later. He reported no interim partners, no symptoms, and was not treated at the TOC visit, however the TOC NG urine NAAT was positive (no culture done). Patient returned for treatment and reported no interim partners. He had light, mucousy urethral discharge, and urethral NG culture from that visit was positive (AZ MIC=2ug/ml). Case C: 41 year old Hispanic HIV-status-unknown male heterosexual treated for NAAT-confirmed NG with AZ/2 grams, presented with persistent urethral discharge 5 weeks after treatment. He reported at least one interim sex partner. Urethral discharge was scant, clear. Urethral NG culture was positive, with AZ MIC >256 ug/ml.
Conclusions: Persistent and recurrent symptoms in men with NG isolates with elevated AZ MIC suggest AZ treatment failure in 3 NYC NG case-patients.