FROM THE BENCH
Monitor Trends
The Wisconsin-Milwaukee SURRG
Program engages cross sector
collaborations across multiple agencies
to maintain the infrastructure needed to
implement, maintain and monitor ARGC
trends. In Wisconsin, these agencies
include five SURRG clinics (one STD clinic
and four non-STD community partner
clinics) in the city of Milwaukee, MHDL,
regional reference AR Lab Network and
CDC laboratories, DSTDP SURRG Program
staff, MHD laboratorians, clinicians,
data analysts, field investigation disease
intervention specialists, WI DPH STD
Program staff, and technical assistance
and epidemiologic consultation from
the Health Care Education and Training
agency (HCET) whose offices are located in
Wisconsin and Indiana.
Local data management and analytic
activities support quality assurance
monitoring, reporting on project
performance measures, inform
programmatic improvements, and
describe social networks to enhance
understanding of the transmission
dynamics of antibiotic resistant GC in
Milwaukee. Clinical, epidemiologic data
and laboratory results are evaluated
and analyzed locally. Selected SURRG
data elements from Milwaukee, WI are
transmitted to CDC as one of the 8 SURRG
project sites contributing data nationally,
to contribute to nationwide susceptibility
and resistance patterns and trends..
These robust collaborations have enabled
swift use of laboratory and clinical data
to improve methods of culture collection
and the use of population-specific
selective criteria for culture collection
to increase detection and recovery rates
of gonorrhea isolates for AST. These
criteria have expanded local capacity
in Milwaukee for prompt detection and
response to resistant gonorrhea identified
through increased culturing of genital and
extragenital sites of sexual activity among
men, men who report sex with men
(MSM) and symptomatic female patients
who are at risk of resistant gonorrhea
infection.
During calendar year 2019, twenty
percent of patients cultured for gonorrhea
in SURRG clinics were identified as
having an Alert isolate, defined as a
GC positive specimen with reducedantimicrobial
susceptibility to at least
one of the antibiotics recommended for
dual treatment of gonorrhea (126 patients
with one or more Alert isolates of 620
GC culture positive patients identified
in SURRG clinics). Of these patients with
Alert isolates, 77% returned for test of
cure and partner services in 2019. The
majority of non-susceptible isolates
(98%) identified in 2019 had reduced
susceptibility to azithromycin. To date, no
known treatment failures have occurred
in Wisconsin.
Next Steps
Maintain capacity: Protocols will be
maintained to ensure identification
of antibiotic resistant gonorrhea by
conducting AST using Etest on at least 15
percent of total reported GC cases in the
jurisdiction per year.
• Provide resources to other
jurisdictions: The MHD Public Health
Laboratory will serve as a GC-AST
testing site and resource for the state of
Wisconsin to integrate GC-culture, AST
and test of cure as routine surveillance
and intervention practices.
• Provide flexible sample collection
options: Implementation of self-collect
swabs for both genital and extra-genital
GC-AST surveillance will increase
identification of ARGC in higher risk
populations.
• Implement advanced molecular
diagnostic surveillance: Development
of culture-independent GC-AST
molecular testing will enhance field
investigations for timely identification
of social networks to mitigate the
spread of GC and ARGC threats locally.
• Inform clinical and public health
partners: Dissemination of these
findings will inform effective clinical
and public health practices and
interventions to prevent and control
transmission of GC and ARGC. n
References
1. CDC. Combating the Threat of Antibiotic-Resistant
Gonorrhea. Available from https://www.cdc.gov/std/
gonorrhea/arg/carb.htm.
2. CDC. Funding Opportunity Description for ELC SURRG
Project 2021
Acknowledgments
STAFF:
Julie Plevak, program assistant, MDHL
Rachel Mukai, epidemiologist, Clinical Services,
MHD Keenan Health Center STD Clinic
Otilio Oyervides, field operations manager, MHD
Keenan Health Center STD Clinic
Darlene Harper, senior technical advisor, CDC
Brandon Kufalk, disease intervention specialist,
WI DPH STD Control Section
Anthony Wade, director, STD Control Section,
WI DPH
Chris Steward, WEDSS program administrator,
WI DPH
PARTNERS:
Jeremy Roseberry, HIV/STD project manager,
HCET
Deb Bonilla, VP of Patient Services, Planned
Parenthood of Wisconsin
Dr. Andy Petroll medical director, Froedtert
Hospital & the Medical College of Wisconsin
Inclusion Health Clinic, Brady Street Clinic BESTD
Ruthie Weatherly, Manager, Brady Street Clinic
BESTD
Dr. Paul Hunter, associate professor, Department
of Family Medicine and Community Health,
University of Wisconsin School of Medicine and
Public Health
Dr. Jessica Dalby, assistant professor,
Department of Family Medicine and Community
Health, University of Wisconsin School of Medicine
and Public Health
CDC’s Division of STD Prevention SURRG
Program Staff
CDC ELC Grant # CK19-1904
3. WI-Milwaukee SURRG Program Performance Measures
2017-2019
4. CDC. Abstract submitted for 2020 STD Conference.
Extragenital Cultures from Women and Men with
Opposite-Sex and Same-Sex Sexual Exposure Are
Important for Antibiotic-Resistant Gonorrhea (ARGC)
Surveillance. J. Pfister 1 , L. Amsterdam 1 , D. Shrestha 1 , C.
Steward 1 , M. Khubbar 2 , R. Gomez 2 , J. Weiner 2 , T. Dasu 2 ,
J. Dalby 3 , H. Hermus 4 , J. Katrichis 4 , S. Bhattacharyya. 2
1
Wisconsin Department of Health Services, 2 City of
Milwaukee Health Department Laboratory, 3 University of
Wisconsin School of Medicine and Public Health, 4 City of
Milwaukee Health Department
PublicHealthLabs
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Spring 2020 LAB MATTERS 17