O09.5 Characteristics of People with Gonorrhea with Reduced Azithromycin Antimicrobial Susceptibility in 8 Jurisdictions in the United States, 2018–2019

Background In the USA, reduced azithromycin susceptibility (AZM-RS) gonococci have been observed in men who have sex with men (MSM), women, and men who have sex with women only (MSW). However AZM-RS prevalence and epidemiological characteristics among women and MSW are not well-described. We examined epidemiological characteristics of MSM and a combined group of women and MSW with susceptible and AZM-RS gonorrhea to investigate differences between groups. Methods We analyzed epidemiological and susceptibility data from people attending STD and community clinics in eight jurisdictions participating in CDC’s Strengthening U.S. Response to Resistant Gonorrhea project during 2018–2019. We defined people with AZM-RS gonorrhea as those with ≥1 gonococcal isolate demonstrating a minimum inhibitory concentration of AZM ≥2.0µg/mL. We used inverse variance weighting to account for heterogeneity in sample size across jurisdictions to estimate pooled AZM-RS prevalences and 95% confidence intervals. Results Across eight sites, 8,859 people (4,521 MSM, 758 women, and 3,580 MSW) provided at least one isolate for susceptibility testing; 1,052 people (10.4% [95% CI: 6.4%–14.4%]) had gonorrhea demonstrating AZM-RS. AZM-RS prevalence was markedly high among MSM (15.1% [95% CI: 10.2%–20.0%]), and lower yet elevated among women and MSW combined (5.3% [95% CI: 2.9%–7.7%]). Among MSM with AZM-RS gonorrhea, 16.2% (95% CI: 10.9%–21.4%) reported having 3+ sexual partners in the last 2–3 months and 16.7% (95% CI: 12.6%–20.9%) reported previous gonococcal infections. Among women/MSW with AZM-RS, 6.2% (95% CI: 3.7%–8.7%) reported 3+ recent sexual partners, and 4.8% (95% CI: 2.4%–7.3%) reported previous gonococcal infections. Conclusions AZM-RS prevalence among women/MSW was lower than among MSM but still elevated, and a lower proportion of women/MSW reported multiple recent sexual partners and previous gonococcal infections. These data highlight differences in the epidemiology of reduced gonococcal susceptibility and the need to tailor resistant gonorrhea control approaches to affected populations.