Targeting culture criteria to maximize culture positivity of Neisseria gonorrhoeae in three sexual health clinic settings.

BACKGROUND: While most gonorrhea (GC) cases in the US are detected using nucleic acid amplification tests (NAATs), isolation of Neisseria gonorrhoeae (NG) using culture specimens is needed for antibiotic susceptibility testing (AST). We present data on NAATs and cultures collected before and during the CDC demonstration project (SURRG) to describe a process to define culture criteria for NG isolation for surveillance of NG with reduced susceptibility. METHODS: For STI clinics in New York City, NY, San Francisco, CA, and Milwaukee, WI, we calculated NAAT positivity by anatomic site in 2016 (pre-SURRG) across three groups: 1) sex partners of persons with GC; 2) patients with symptoms (e.g., urethral or cervical discharge); 3) patients who had tested positive and were returning for GC treatment, and compared it with positivity among all other patients. We then examined SURRG-period NAAT positivity among patients from whom a culture was or was not collected, and culture positivity, by specimen site and jurisdiction. RESULTS: Pre-SURRG, NAAT positivity across the three select groups was at least twice that of patients who did not meet any criteria. SURRG-period NAAT positivity was higher among patients from whom a culture was also collected. Overall culture positivity was relatively high (NYC:34.8%, SF:26.7%, Milwaukee:24.8%); the proportion of specimens tested widely varied (range 5.7%-26.5%) by jurisdiction. CONCLUSIONS: NAAT data evaluation can inform the establishment of criteria for culture collection for AST. Routine evaluation and quality improvement activities related to culture collection/isolation techniques could increase NG isolation for AST.