(P95) Trends in Estimated Rates of Reported Neisseria gonorrhoeae Cases by Anatomic Site, Seven U.S. Jurisdictions, STD Surveillance Network, 2016 – 2021

Background

The number of N. gonorrhoeae (NG) cases diagnosed and reported is sensitive to changes in screening/testing patterns. Reported cases have recently risen in the U.S. Contemporaneously, the availability of screening at extragenital anatomic sites (e.g., rectum, pharynx) has expanded for patients. Previously, many asymptomatic infections at non-genital sites would have gone undiagnosed and unreported. Anatomic site of infection is not routinely available in national case reporting. We estimated rates of reported NG by anatomic site of infection using a representative sample of reported NG cases from a sentinel STD surveillance project that ascertains anatomic site of infection from all available sources.

Methods

Seven U.S. jurisdictions collaborating in the STD Surveillance Network (SSuN) conducted investigations on a representative sample of all NG cases reported, linking laboratory data with information obtained from diagnosing providers. Cases reported 2016-2021 were weighted, adjusting for non-response by sex and age. Estimates of the number of overall cases by anatomic site(s) were calculated. We estimated NG case rates for genital versus extragenital infections, assessing trends by anatomic site and population characteristics.

Results

Among 506,742 NG cases reported, 67,318 were randomly sampled and investigations were completed for 29,552 (43.9%). The proportion of cases reported with only extragenital infections increased significantly from 34.2% in 2016 to 39.4% in 2019 (p< 0.0001), then decreased in 2020 and 2021 to 35.1% and 34.9%, respectively. Among men who have sex with men, those reported with only rectal/pharyngeal infections increased from 54.4% in 2016 to 65.9% in 2019 (P< 0.0001), then decreased in 2020 and 2021 to 61.2% and 62.1%, respectively. In 2021, estimated case rate for all reported NG in these jurisdictions was 245.1 per 100,000; excluding extragenital-only infections, the estimate was 22.6% lower (189.7 per 100,000). A similar effect was noted throughout the study period.

Conclusions

Reported rates of NG are augmented by extragenital infections, which would not have been diagnosed and reported prior to widespread extragenital screening. While COVID-19 likely depressed trends in all site testing in 2020-2021, historical trends in NG incidence should be interpreted cautiously considering these findings, reinforcing the importance of monitoring infections by anatomic site.