Risk Factors and Antimicrobial Resistance Profiles of Neisseria gonorrhoeae Associated with Repeat Gonococcal Infections in Patients Attending Public Health Seattle and King County Sexual Health Clinic, 2017 to 2020

Abstract

This study sought to determine what characteristics were risk factors associated with repeat gonococcal infection (GCI) in one US sexual health clinic (SHC) and compared the resistance profiles of Neisseria gonorrhoeae (Ng) isolates from repeat GCI patients versus patients with single GCI. This is a secondary analysis of the Centers for Disease Control and Prevention’s Strengthening the United States Response to Resistant Gonorrhea (SURRG) surveillance data from February 2017 to December 2020 for persons seeking care at the Public Health–Seattle & King County (PHSKC) SHC who were diagnosed with gonorrhea. A gonorrhea-positive case was defined as the presence of Ng confirmed by a positive lab culture result or nucleic acid amplification test (NAAT) in a specimen collected from one or more anatomical sites (e.g., urethra, cervix, rectum, pharynx). Univariable and multivariable logistic regression was used to evaluate the association between potential correlates and repeat GCI, the outcome of interest. Using chi-square test to assess proportion of antibiotic-resistant (AR) Ng isolates between patients with repeat GCI and single GCI, we compared an alternative hypothesis which assumed that the proportion of Ng isolates from repeat GCI will be higher than the proportion of AR Ng isolates from single GCI. Between February 2017 and December 2020, 2,219 unique SHC patients had at least one episode of gonorrhea. Of these 2,219 patients, 577 had a repeat GCI and 1,642 patients had no additional positive results. Among the 2,219 individual patients, 2,003 (90.3 %) were men and 169 (7.6 %) were women. Among men, 1,605 (72.3%) reported only male sex partners. In the bivariable model, documented history of gonorrhea in the Washington State STD surveillance registry (which started in 2007) at the time of the initial GCI in this dataset had the strongest association with repeat GCI (OR=2.1; 95% CI: 1.7, 2.6). Self-reported history of gonorrhea ever (OR=1.4; 95%CI: 1.1, 1.8), documented history of gonorrhea in the registry (OR=2.1; 95% CI: 1.7, 2.6), current pre-exposure prophylaxis use (OR=1.6; 95% CI: 1.3, 2.0) and history of non-injection recreational drug use in previous 12 months (OR=1.7; 95% CI: 1.3, 2.1) remained statistically significant and were positively associated with repeat GCI in the multivariable model. There was no gentamicin resistance recorded for either single or repeat GCI. Of the seven antibiotics used for agar dilution AST, gonococcal isolates from repeat GCI had higher proportion of resistance for penicillin (repeat= 18.0%, single 11.2%; p-value 0.001), tetracycline (repeat= 32.2%, single 19.9%; p-value <0.001), and ciprofloxacin (repeat= 55.1%, single 36.1%; p-value <0.001). Gonorrhea prevention interventions to increase routine testing and prevention counselling should target men, MSMs, people with a history of gonorrhea and people older than 25 years, who face an increased risk for repeat GCI.