Background: In Massachusetts (MA), identification of two cases of a novel strain of gonorrhea carrying the penA-60.001 allele indicative of ceftriaxone non-susceptibility prompted release of a clinical alert on January 19, 2023, recommending gonorrhea culture alongside nucleic acid amplification tests, and ascertainment of travel history, for patients with symptoms compatible with gonorrhea infection. The aim of this analysis is to describe characteristics and results of antibiotic susceptibility testing (AST) from cases with positive gonorrhea cultures reported to MA Department of Public Health (MDPH) in the first 30 days since the clinical alert.
Methods: We assessed demographic (age, gender, race/ethnicity) and laboratory characteristics (anatomic site of testing, AST results) for all cases with positive gonorrhea cultures reported to MDPH between January 19 and February 18, 2023. Social vulnerability was estimated with the Center for Disease Control and Prevention’s Social Vulnerability Index. Chart review (n=32) or follow-up with clinical providers when chart access was not available, (n=17) was performed to ascertain additional factors such as current gender, number of sex partners and travel history.
Results: From January 19 through February 18, there were 49 cases with at least one positive gonorrhea culture reported to MDPH (see Table). Of these, most were male (84%), 20-29 years (51%), and identified as men who have sex with men (51%). Approximately 80% resided in a moderately high or highly vulnerable census tract across the state. Exact number of sex partners was inconsistently reported. Few had documented travel histories (24%). Of those, only one reported recent travel abroad. Among those with AST (n=47), 38% carried isolates resistant to ciprofloxacin. All isolates demonstrated susceptibility to ceftriaxone, cefixime, cefoxitin, azithromycin, and spectinomycin. Among cases with isolates from >1 anatomic site, no discordant susceptibility profiles were identified.
Conclusion: In the one month after scale-up of gonorrhea culture surveillance in MA, we found that culture-positive symptomatic gonorrhea cases were distributed across the state and largely represented male individuals residing in moderately high or highly vulnerable census tracts. Number of sex partners and travel history were inconsistently documented. Susceptibility testing revealed significant ciprofloxacin resistance but no further cephalosporin, macrolide, or aminoglycoside resistance.
