Estimating the incidence of antimicrobial resistant Neisseria gonorrhoeae in the United States among men and women aged 15-39 years, 2008-2019.

Abstract

Background: The Gonococcal Isolate Surveillance Project (GISP) was established to monitor antimicrobial resistance (AR) in N. gonorrhoeae in the United States. Isolates collected in GISP undergo antimicrobial susceptibility testing allowing for estimates of resistance, based on exceeding minimum inhibitory concentrations (MICs), to be calculated.

Methods: We estimated the annual number and proportion of gonococcal infections with antibiotic resistance or elevated MICs (AR/eMICs) against six antibiotics for men and women aged 15 to 39 years in the US using male urethral specimens collected in GISP during 2008-2019. Although GISP only measured MICs for male gonococcal infections, this study estimated AR/eMICs in women using data from men with female sex partners. GISP data were weighted against national gonorrhea case report data based on four variables (age group, year of report, US Census region, and race/Hispanic ethnicity) to estimate annual, national proportions of gonococcal infections with AR/eMICs. These weighted proportions were then multiplied by national estimates of incident gonococcal infections to calculate the number of incident gonococcal infections with AR/eMICs nationally.

Results: Women had a higher estimated number of cases with AR/eMICs compared with men (440,900 vs. 387,200 in 2019) although the estimated percentage of gonococcal infections with AR/eMICs was lower in women (50.7% vs. 54.4% in 2019). Elevated MICs to ceftriaxone remained below 1% throughout the study period.

Conclusions: Our analysis indicates that there are more women with AR/eMICs gonorrhea than men. Although the proportion of cases that are resistant to any one antimicrobial is increasing, eMICs to ceftriaxone remains low.