Lindley A Barbee1,2, Olusegun O Soge3,4, David A Katz1,2, Julia C Dombrowski1,2,5, King K Holmes1,2,3,5, Matthew R Golden1,2,5. 1. Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington. 2. HIV/STD Program, Public Health-Seattle & King County. 3. Department of Global Health. 4. Neisseria Reference Laboratory and Chlamydia Laboratory. 5. Department of Epidemiology, University of Washington, Seattle.
Abstract
Background: Antimicrobial-resistant Neisseria gonorrhoeae is a major public health threat. The Centers for Disease Control and Prevention (CDC) recommends ceftriaxone 250 mg plus azithromycin (AZM) 1 g for gonorrhea treatment. Resistance to AZM could affect gonorrhea control efforts. Methods: Using gonococcal isolates collected at the Public Health-Seattle & King County (PHSKC) Sexually Transmitted Disease (STD) Clinic from 2012 to 2016, focusing on 2014-2016, we compared cases with the CDC AZM alert value minimum inhibitory concentration (MIC) (≥2 µg/mL) to those with AZM MIC ≤1 µg/mL, antimicrobial susceptibility profiles and clinical outcomes. Results: In 2012 and 2013, none of the 263 patients from whom we isolated N. gonorrhoeae from the urethra were infected with organisms with an AZM MIC ≥2 µg/mL. Between 2014 and 2016, 4.4% of 926 gonorrhea cases demonstrated reduced susceptibility to AZM; 93% of these cases occurred among men who have sex with men (MSM). Among MSM, 5.0% of 2014-2016 cases demonstrated reduced susceptibility to AZM. No AZM alert value isolates had concomitant cephalosporin resistance. There were 2 potential treatment failures: 1 pharyngeal infection treated with AZM 2 g alone, and 1 pharyngeal infection that persisted after study drug. Conclusions: Among MSM with gonorrhea in Seattle, 5% have gonorrhea with reduced susceptibility to AZM. The World Health Organization recommends changing treatment guidelines when >5% of isolates are resistant to a recommended drug. The emergence of resistant AZM gonorrhea should prompt reconsideration of current treatment recommendations, and highlights the need for new therapies for gonorrhea.
Background: Antimicrobial-resistant Neisseria gonorrhoeae is a major public health threat. The Centers for Disease Control and Prevention (CDC) recommends ceftriaxone 250 mg plus azithromycin (AZM) 1 g for gonorrhea treatment. Resistance to AZM could affect gonorrhea control efforts. Methods: Using gonococcal isolates collected at the Public Health-Seattle & King County (PHSKC) Sexually Transmitted Disease (STD) Clinic from 2012 to 2016, focusing on 2014-2016, we compared cases with the CDC AZM alert value minimum inhibitory concentration (MIC) (≥2 µg/mL) to those with AZM MIC ≤1 µg/mL, antimicrobial susceptibility profiles and clinical outcomes. Results: In 2012 and 2013, none of the 263 patients from whom we isolated N. gonorrhoeae from the urethra were infected with organisms with an AZM MIC ≥2 µg/mL. Between 2014 and 2016, 4.4% of 926 gonorrhea cases demonstrated reduced susceptibility to AZM; 93% of these cases occurred among men who have sex with men (MSM). Among MSM, 5.0% of 2014-2016 cases demonstrated reduced susceptibility to AZM. No AZM alert value isolates had concomitant cephalosporin resistance. There were 2 potential treatment failures: 1 pharyngeal infection treated with AZM 2 g alone, and 1 pharyngeal infection that persisted after study drug. Conclusions: Among MSM with gonorrhea in Seattle, 5% have gonorrhea with reduced susceptibility to AZM. The World Health Organization recommends changing treatment guidelines when >5% of isolates are resistant to a recommended drug. The emergence of resistant AZMgonorrhea should prompt reconsideration of current treatment recommendations, and highlights the need for new therapies for gonorrhea.
Authors: Matthew R Golden; William L H Whittington; H Hunter Handsfield; James P Hughes; Walter E Stamm; Matthew Hogben; Agnes Clark; Cheryl Malinski; Jennifer R L Helmers; Katherine K Thomas; King K Holmes Journal: N Engl J Med Date: 2005-02-17 Impact factor: 91.245
Authors: Fabian Yuh Shiong Kong; Sepehr N Tabrizi; Christopher Kincaid Fairley; Lenka A Vodstrcil; Wilhelmina M Huston; Marcus Chen; Catriona Bradshaw; Jane S Hocking Journal: J Antimicrob Chemother Date: 2015-01-29 Impact factor: 5.790
Authors: Robert D Kirkcaldy; Olusegun Soge; John R Papp; Edward W Hook; Carlos del Rio; Grace Kubin; Hillard S Weinstock Journal: Antimicrob Agents Chemother Date: 2014-12-01 Impact factor: 5.191
Authors: Severin O Gose; Olusegun O Soge; James L Beebe; Duylinh Nguyen; Juliet E Stoltey; Heidi M Bauer Journal: Sex Transm Dis Date: 2015-05 Impact factor: 2.830
Authors: I Martin; P Sawatzky; G Liu; V Allen; B Lefebvre; L Hoang; S Drews; G Horsman; J Wylie; D Haldane; R Garceau; S Ratnam; T Wong; C Archibald; M R Mulvey Journal: Emerg Infect Dis Date: 2016-01 Impact factor: 6.883
Authors: John R Papp; A Jeanine Abrams; Evelyn Nash; Alan R Katz; Robert D Kirkcaldy; Norman P O'Connor; Pamela S O'Brien; Derek H Harauchi; Eloisa V Maningas; Olusegun O Soge; Ellen N Kersh; Alan Komeya; Juval E Tomas; Glenn M Wasserman; Gail Y Kunimoto; David L Trees; A Christian Whelen Journal: Emerg Infect Dis Date: 2017-05 Impact factor: 6.883
Authors: Scott W Olesen; Elizabeth A Torrone; John R Papp; Robert D Kirkcaldy; Marc Lipsitch; Yonatan H Grad Journal: J Infect Dis Date: 2019-01-29 Impact factor: 5.226
Authors: Jose A Bazan; Mysheika Williams Roberts; Olusegun O Soge; Elizabeth A Torrone; Amanda Dennison; Melissa Ervin; Sopheay Hun; Karen S Fields; Abigail N Turner Journal: Sex Transm Dis Date: 2018-02 Impact factor: 2.830
Authors: Adam L Bailey; Robert F Potter; Meghan A Wallace; Caitlin Johnson; Gautam Dantas; C A Burnham Journal: mSphere Date: 2019-07-24 Impact factor: 4.389