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BACKGROUND: Emerging gonococcal cephalosporin resistance is an urgent public health threat. Gonococcal cefixime minimum inhibitory concentrations (MICs) increased in the US during 2006-2010; the largest increases were observed in the West and among men who have sex with men (MSM). In response, CDC updated its treatment recommendations in 2012 and now recommends ceftriaxone-based dual therapy as the only first-line option. We describe the most recent US gonococcal antimicrobial susceptibility trends.
METHODS: The Gonococcal Isolate Surveillance Project (GISP) conducts surveillance of antimicrobial susceptibility in urethral isolates from symptomatic men with gonorrhea attending clinics for sexually transmitted diseases. MICs are determined by agar dilution conducted in 5 regional laboratories, and clinical information is abstracted from medical records.
RESULTS: 25,308 isolates were collected during 2009–June 2013 from 25-30 sentinel STD clinics throughout the United States. 66.1% of isolates were collected from African-American men, 16.9% from whites, and 10.9% from Latinos. Of men with available sex of sex partner information (n=24,777), 29.9% were men who have sex with men (MSM); 25.3% were MSM in 2009 and 34.7% were MSM in 2013 (p<0.001). Overall, 25.3% of MSM were HIV-infected. Of all men, 47.5% reported a prior history of gonorrhea and 2.1% reported sex work exposure. The percentage of isolates with elevated cefixime MICs (MIC ≥0.25 µg/ml) increased from 0.8% (2009) to 1.4% (2010 and 2011), then decreased to 0.4% in 2013. The percentage of isolates with elevated ceftriaxone MICs (MIC ≥0.125 µg/ml) increased slightly during 2009–2011 and then decreased to 0.1% in 2013. The prevalence of ciprofloxacin-resistance increased from 9.6% in 2009 to 16.0% in 2013. The prevalence of isolates with reduced azithromycin susceptibility (MIC ≥ 2 µg/ml) ranged from 0.2% to 0.5% between 2009 and 2013 with no apparent trends.
CONCLUSIONS: The percentage of isolates with elevated cephalosporin MICs remains low without increases in the last two years. Although encouraging, continued surveillance, adherence to current treatment guidelines, and the search for new drugs and drug regimens to treat gonorrhea remain critical.