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Background: Men attending New York City (NYC) STD clinics have anal and oropharyngeal specimens collected for Neisseria gonorrhoeae(NG) culture if they report sexual exposure at those sites; urethral culture is done for all men treated presumptively with a non-recommended regimen, and for men with urethral discharge attending one clinic surveilling for NG antibiotic resistance. Antibiotic susceptibility testing (AST) performed at NYC Public Health Laboratory includes azithromycin (E-test). We describe the frequency of NG isolates with reduced susceptibility to azithromycin, and case-patient characteristics.
Methods: NG isolates exhibiting a minimum inhibitory concentration (MIC) of ≥2.0µg/mL of azithromycin were defined as having reduced susceptibility. Case-patients were characterized with respect to age, sexual behavior, HIV status, treatment history using data extracted from the STD clinic Electronic Medical Record (EMR). SPSS was used for analysis.
Results: During January 2013-December 2015, there were 28,060 male NG cultures performed at NYC STD clinics; the number of cultures performed declined from 2013 (n=11,613) to 2015 (n=8,241). Overall, 4.3% (179/4,153) of anal cultures, 0.8% (176/20,769) oropharyngeal cultures, and 33.5% (1050/3138) urethral culture specimens were positive and had AST for azithromycin. A total of 33 (2.3%) NG isolates (4 anorectal, 11 oropharyngeal, 18 urethral) from 30 patients exhibited reduced susceptibility to azithromycin; 7 in 2013 (median MIC=2ug/ml, range 2-16), 11 in 2014 (median MIC=6ug/ml, range 2-265), and 15 in 2015 (median MIC= 4ug/ml, range 2-256). Median age of case-patients was 27 years (range 18-55); most (25/30) were men-who-have-sex-with-men. 10% (3/30) were HIV positive; and 8 were treated solely with azithromycin.
Conclusions: Since 2013, the number of NG isolates with reduced susceptibility to azithromycin detected at NYC public STD clinics has increased. In the absence of culture with AST results that include azithromycin, providers should consider test-of-cure for male patients treated only with azithromycin for laboratory-confirmed NG.