P679\u2005Neisseria gonorrhoeae (GC) culture positivity by indication for culture and anatomic site, seattle, washington, 2017–2018

Abstract

Background In order to increase the number of gonococcal isolates available for antimicrobial susceptibility surveillance, we expanded indications for GC culture in a municipal STD clinic in Seattle, Washington. We evaluated GC culture positivity by clinical criteria. Methods In 2017–2018, GC culture specimens were collected from STD clinic patients who met these criteria: (1) contact to GC, (2) GC NAAT+ not yet treated, or (3) symptomatic urethritis/cervicitis with intracellular diplococci on gram stain. Clinicians inoculated Modified Thayer-Martin agar plates at the bedside and incubated in a candle jar. Patient characteristics and indication for culture were abstracted from medical records; culture positivity was compared by indication, anatomic site, and patient group with Fisher’s exact test. Results Clinicians collected a total of 3,884 specimens, of which 1,107 (29%) were GC culture positive. Culture positivity among 74 endocervical, 1,611 pharyngeal, 1,154 rectal, and 1,045 urethral isolates was 30%, 17%, 29%, and 46%, respectively. Among contacts to GC, endocervical culture positivity was 6/26 (23%), pharyngeal 79/752 (11%), rectal 88/549 (16%), and urethral 71/445 (16%). Urethral culture positivity in male contacts without urethral discharge was low (6/221 [3%]). Pharyngeal culture positivity among GC contacts who were men who have sex with men was similar to heterosexual men (10% of 719 vs 12% of 17, p=0.68) but lower than pharyngeal positivity among women (43% of 14, p<0.01). Among patients with a recent NAAT+ screening test, cultures were positive in 12/35 (34%) endocervical, 133/514 (26%) pharyngeal, 168/337 (50%) rectal, and 30/94 (32%) urethral specimens. Most (91% of 476) men with urethritis and intracellular diplococci on gram stain were culture positive. Conclusion Men with symptomatic urethritis had the highest GC culture yield (91%), followed by persons with recent GC NAAT+ (26–50%). Cultures in GC contacts had a modest yield (11%–23%). These criteria were appropriate for obtaining GC isolates for antimicrobial surveillance. Disclosure No significant relationships.