title: Comparison of antimicrobial susceptibilities of pharyngeal, rectal, and urethral Neisseria gonorrhoeae isolates among men who have sex with men.
abstract: U.S. surveillance for Neisseria gonorrhoeae antimicrobial susceptibilities is based exclusively on male urethral isolates. These data inform gonorrhea treatment guidelines, including recommendations for the treatment of extragenital infections, but data on the susceptibilities of extragenital isolates are limited. We compared the antimicrobial susceptibilities of pharyngeal, rectal, and urethral gonococcal isolates collected from men who have sex with men (MSM), at five sentinel sites throughout the United States. MICs were determined by the agar dilution method. Generalized linear models were used to compare (i) the proportions of isolates with elevated MICs and (ii) geometric mean MICs according to anatomic site, adjusted for city. In December 2011 to September 2013, totals of 205 pharyngeal, 261 rectal, and 976 urethral isolates were obtained. The proportions of isolates with elevated ceftriaxone MICs (≥ 0.125 μg/ml) did not differ according to anatomic site (0.5% of pharyngeal isolates, 1.5% of rectal isolates, and 1.7% of urethral isolates, with a city-adjusted odds ratio [aOR] of 0.4 [95% confidence interval {CI}, 0.0 to 3.9] for pharyngeal versus urethral isolates and an aOR of 0.9 [95% CI, 0.2 to 4.2] for rectal versus urethral isolates). The city-adjusted geometric mean ceftriaxone MICs of pharyngeal (0.0153 μg/ml) and rectal (0.0157 μg/ml) isolates did not differ from that of urethral isolates (0.0150 μg/ml) (ratios of geometric mean MICs of 1.02 [95% CI, 0.90 to 1.17] and 1.05 [95% CI, 0.93 to 1.19], respectively). Similar results were observed for other antimicrobials, including cefixime and azithromycin. These findings suggest that, at the population level, gonococcal antimicrobial susceptibility surveillance based on urethral isolates from MSM adequately reflects the susceptibilities of N. gonorrhoeae strains circulating among MSM.
authors.affiliation: Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA skidd@cdc.gov.
authors.forename: Sarah
authors.initials: S
authors.lastname: Kidd
authors.affiliation: Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
authors.forename: Akbar
authors.initials: A
authors.lastname: Zaidi
authors.affiliation: Philadelphia Department of Public Health, Philadelphia, Pennsylvania, USA.
authors.forename: Lenore
authors.initials: L
authors.lastname: Asbel
authors.affiliation: Laboratory Services Section, Texas Department of State Health Services, Austin, Texas, USA.
authors.forename: Tamara
authors.initials: T
authors.lastname: Baldwin
authors.affiliation: Howard Brown Health Center, Chicago, Illinois, USA.
authors.forename: Beau
authors.initials: B
authors.lastname: Gratzer
authors.affiliation: Los Angeles County Department of Public Health, Los Angeles, California, USA.
authors.forename: Sarah
authors.initials: S
authors.lastname: Guerry
authors.affiliation: University of Washington and Public Health-Seattle and King County, Seattle, Washington, USA.
authors.forename: Roxanne P
authors.initials: RP
authors.lastname: Kerani
authors.affiliation: New York City Department of Health and Mental Hygiene, New York, New York, USA.
authors.forename: Preeti
authors.initials: P
authors.lastname: Pathela
authors.affiliation: Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
authors.forename: Kevin
authors.initials: K
authors.lastname: Pettus
authors.affiliation: Neisseria Reference Laboratory, University of Washington, Seattle, Washington, USA.
authors.forename: Olusegun O
authors.initials: OO
authors.lastname: Soge
authors.affiliation: Los Angeles County Department of Public Health, Los Angeles, California, USA.
authors.forename: Ali
authors.initials: A
authors.lastname: Stirland
authors.affiliation: Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
authors.forename: Hillard S
authors.initials: HS
authors.lastname: Weinstock
mesh_terms: D000890:Anti-Infective Agents / Q000494:pharmacology*; D018451:Homosexuality, Male; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D009344:Neisseria gonorrhoeae / Q000187:drug effects*; D010614:Pharynx / Q000382:microbiology*; D012007:Rectum / Q000382:microbiology*; D014521:Urethra / Q000382:microbiology*
chemical_list: D000890:Anti-Infective Agents