FROM THE BENCH
Strengthening United States Response
to Resistant Gonorrhea in Wisconsin
by Lori Amsterdam, MPH, epidemiology coordinator, Wisconsin Division of Public Health Bureau of Communicable Diseases;
and Sanjib Bhattacharyya, PhD, laboratory director and special deputy health commissioner, City of Milwaukee Health Department
Background
Gonorrhea (GC) is the second most
commonly reported notifiable disease
in the United States, with more than
500,000 reported cases of gonorrhea per
year and an estimated 1.14 million new
infections that may actually occur each
year. Of these infections, half are found
to be resistant to at least one antibiotic.
Gonorrhea control relies on jurisdictional
ability to detect and treat each case of
gonorrhea quickly and effectively with the
right antibiotic.
In 2013, the US Centers for Disease
Control and Prevention (CDC) released
the first report to look at the burden and
threats posed by antibiotic-resistant
gonorrhea (ARGC) as one of the three
most urgent threats of its kind in the
country. As outlined in the National
Action Plan for Combating Antibiotic
Resistant Bacteria (CARB), the US Centers
for Disease Control and Prevention’s
Division of STD Prevention (DSTDP)
began supporting new and continuing
multipronged activities in fiscal year
2016 to slow the development and spread
of ARGC.
Surveillance for Antibiotic Resistant
Gonorrhea
In 2016, the Wisconsin Department of
Health Services, Division of Public Health,
STD Control Section (WI DPH STD), in
collaboration with the Milwaukee Health
Department and Laboratory (MHDL),
competed successfully as one of nine
national sites to receive DSTDP CARB
funding through the Epidemiology and
Laboratory Capacity (ELC) initiative for
Strengthening the United States Response
to Resistant Gonorrhea (SURRG). To better
understand the epidemiologic factors
that contribute to resistant gonorrhea,
SURRG surveillance activities have been
implemented in these nine, high GC
morbidity jurisdictions. Activities include
collection of specimens for culture and
antibiotic susceptibility testing (AST)
using Etest, a rapid method for detecting
non-susceptible isolates. Two of the four
regional laboratories in the Antibiotic
Resistant Lab Network (AR Lab Network)
are assigned to receive shared SURRG
GC isolates from the MHDL to perform
confirmatory AST on a broad panel
of antibiotics currently or previously
recommended for gonorrhea treatment
including but not limited to azithromycin,
ceftriaxone, cefixime and gentamycin.
SURRG project staff in Wisconsin also
focus efforts to document additional
clinical, laboratory and enhanced field
investigation data elements, confirm
infection resolution in patient cases,
test and treat partners and identify
local social networks to assess local
transmission dynamics and contribute to
the development of national guidance and
recommendations for an effective public
health response to resistant gonorrhea.
MHDL also serves as a sentinel site in
Wisconsin for the Gonococcal Isolate
Surveillance Project (GISP). This project is
limited to sharing isolates and AST data
from the MHDL with CDC for the first 25
gonorrhea isolates identified each month
among males attending the MHD STD
clinic, which also serves as the categorical
STD SURRG clinic in Milwaukee.
Additional authors
Raquel Gomez, M(ASCP)CM, Microbiologist,
City of Milwaukee Health Department
Josh Weiner, MS, laboratory data specialist, City
of Milwaukee Health Department
Dhana Shrestha, MPH, epidemiology analyst,
STD Control Section, Wisconsin Division of Public
Health Bureau of Communicable Diseases
Manjeet Khubbar, M.Sc., lead microbiologist, City
of Milwaukee Health Department
Helen Hermus, MS, BSN, RN, public health nurse
supervisor, City of Milwaukee Health Department
Figure 1: Milwaukee SURRG Clinic Alert and non-Alert Isolates by Month and Specimen Type Top: Total non-alert and alert isolates
by anatomical site of infection April 2017-December 2019. Darker bars: alert isolates, Lighter bars: non-alerts. Percent alert by
specimen type shown alongside each bar. Bottom: Alert isolates identified in SURRG clinics by month July 2017-December 2019.
AZI: Azithromycin; AZI-QS: Azithromycin Quick Send (MIC >16); CFX: Cefixime; CRO: Ceftriaxone
John Pfister, MS, epidemiology consultant for
Health Care Education and Training (HCET)
Trivikram Dasu, PhD, D(ABMLI), deputy laboratory
director, City of Milwaukee Health Department
16 LAB MATTERS Spring 2020
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