Background
Gonorrhea, caused by N. gonorrhoeae, has developed resistance to most antimicrobial treatments over time, including ciprofloxacin, tetracycline, penicillin, and cephalosporins. Importantly, baseline tetracycline resistance may impact the use of doxycycline as post-exposure prophylaxis (DoxyPEP) to prevent bacterial STIs. We evaluated baseline N. gonorrhoeae resistance in patients presenting to a community-based STI clinic.
Methods
We reviewed demographic and behavioral data of patients presenting for HIV/STI testing at a community-based STI clinic in Providence, Rhode Island, between February 2023, and May 2024. N. gonorrhoeae was detected using nucleic acid amplification tests (NAAT). Bivariate and multivariate analyses were conducted to examine the factors that were associated with having at least one positive gonorrhea test.
Results
A total of N=802 unique patients presented for HIV/STI testing. The median age was 31 years. The majority of patients were assigned male at birth (72%) and self-identified as non-heterosexual (75%). The majority of patients reported a prior history of STIs (52%), including chlamydia (45%), syphilis (20%), and gonorrhea (37%). Twelve out of 802 patients (1.5%) were HIV positive and 25% were actively using HIV PrEP. Additionally, 18% of patients reported the use of DoxyPEP. Sixteen percent (N=127) had at least one positive gonorrhea test during the study period. No statistically significant differences were observed across different racial and ethnic groups. People taking HIV PrEP were significantly more likely to test positive for gonorrhea (aOR: 3.00, 95% CI: 2.53-6.34) compared to those not on PrEP. Having a history of STIs, a moderate or high number of sexual partners, and engaging in sex with anonymous partners were all associated with significantly elevated odds of testing positive for gonorrhea. Among the 127 patients with at least one positive gonorrhea test, 116 had swab samples available for culture testing. Of these, 30 patients had positive culture results. All N. gonorrhoeae isolates were sensitive to Ceftriaxone, but only 10% were pan-sensitive. Sixty-percent (N=18) demonstrated some resistance to ciprofloxacin, 33% (N=10) to tetracyclines, and 0.03% (N=1) to cefixime.
Conclusions
Antimicrobial resistance to N. gonorrhoeae is common and may limit effectiveness of HIV/STI prevention approaches such as DoxyPEP. New approaches to address antimicrobial resistance among N. gonorrhoeae and continued surveillance are needed.