Increases in Neisseria gonorrhoeae with Reduced Susceptibility to Azithromycin among Men who have sex with Men (MSM), in Seattle, King County, Washington: 2012 – 2016

Abstract

Background

Antimicrobial-resistant Neisseria gonorrhea is a major public health threat. The CDC recommends that clinicians treat gonorrhea with ceftriaxone 250mg plus azithromycin 1g. Resistance to azithromycin could affect gonorrhea control efforts.

Methods

We evaluated antimicrobial susceptibility profiles and clinical data of gonococcal isolates collected at the Public Health–Seattle & King County (PHSKC) STD Clinic from 2012–2016, focusing on 2014–2016. We compared cases with CDC azithromycin (AZM) alert value MIC (MIC ≥2 µg/mL) to those with AZM MIC ≤1 µg/mL, and evaluated clinical outcomes.

Results

In 2012 and 2013, none of the 263 patients from whom we isolated N. gonorrhoeae were infected with organisms with an AZM MIC ≥2 µg/mL. Between 2014–2016, 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, 5.4%, 4.8% and 4.6% of cases from 2014, 2015, and 2016, respectively, and 5.0% cumulatively, demonstrated reduced susceptibility to AZM. No AZM alert value isolates had concomitant cephalosporin resistance. There were 2 potential treatment failures: one pharyngeal infection treated with azithromycin 2g alone, and one pharyngeal infection that persisted after a 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 potentially resistant AZM gonorrhea should prompt reconsideration of current treatment recommendations, and highlights the need to develop new therapies for gonorrhea.