1534 - Gonorrhea Testing and Ceftriaxone Resistance in the Department of Veterans Affairs (VA), 2010-2019

Background: Gonorrhea (GC) infections caused by Neisseria gonorrhoeae are an ongoing public health issue and have shown resistance to nearly all antibiotic classes, including cephalosporins which are a CDC recommended treatment. We investigated national GC testing and Ceftriaxone resistance in VA.

Methods: GC cases identified from VA data sources from 1/1/2010-12/15/2019 by either molecular laboratory testing or GC culture with sensitivity testing.  Patients were reviewed for positive results, whether culture testing was performed after 2 positive molecular GC results in < 90 days, and sensitivity patterns.

Results: 10,642 of 644,968 (2%) GC molecular results were positive with annual number of positive cases (1,365 to 3,225), number of tests performed (97,636 to 164,085) and percent positive for GC (1.4% to 2%) increasing over the time period studied.  2,358/10,642 (22%) of positive molecular test results had repeat testing < 3mo with 351 (15%) positive on repeat testing which is concerning for possible resistance.  2,624 GC cultures were performed with 2,179 (83%) positive.  1,480/2,179 (68%) positive GC culture tests had some sensitivity testing performed.    Culture testing remained stable with 287 in 2010 to 289 in 2019 with percent positive ranging from 78-89%.  Of the 351 patients with repeat positive GC molecular testing done < 3mo from their positive molecular test, only 18 (5%) had GC culture testing performed proximal to the second positive test.  Among all cultured isolates, resistance to Ceftriaxone was noted in 1 sample in 2017 in Missouri (also intermediate resistance to Tetracycline) and 1 in 2019 in New Jersey (also resistant to Penicillin, Tetracycline, and Ciprofloxacin).

Conclusion: In VA, GC infections have increased from 2010 to 2019 and GC culture testing has remained stable despite increasing molecular testing.  Only 2 samples were identified with Ceftriaxone resistance.  However, the low percentage of GC culture testing after persistent positive molecular testing in VA could mask treatment failures and possible resistance.  Culture testing with sensitivity testing should be increased in VA in cases where patients may have resistance to initial treatments (i.e., – repeat positive testing less than 3 months after a positive test).