O08.4 Strengthening the U.S. Response to Resistant Gonorrhea (SURRG): A program to enhance local antibiotic resistant gonorrhea preparedness capacity

Background/Purpose In 2016 the U.S. Centers for Disease Control and Prevention (CDC) initiated Strengthening the U.S. Response to Resistant Gonorrhea (SURRG) in local jurisdictions to enhance antibiotic resistant gonorrhea (ARGC) rapid detection and response infrastructure and evaluate the impact of key strategies. Approach Eight jurisdictions were funded for five years to establish or enhance local specimen collection for gonococcal cultures in STD and community clinics, conduct rapid antibiotic susceptibility testing (AST) using Etest® in local public health laboratories, modify surveillance systems for enhanced data collection and rapid communication of AST results, and initiate partner services and investigations among patients with GC demonstrating reduced susceptibility (RS) to ceftriaxone, cefixime or azithromycin. Outcomes/Impact SURRG grantees incorporated robust genital, pharyngeal, and rectal gonococcal culture collection from all genders at participating clinics. During 2018–2019, grantees performed AST on >10,700 isolates with a five-day median turnaround time from specimen collection to reporting AST results to providers. Fifty-nine percent of patients with RS GC returned for a test-of-cure; no resistance-related treatment failures were detected. Among 4,511 isolates, we found ≥95% concordance (within one doubling dilution) between AST performed locally using Etest® compared to agar dilution (reference method) for ceftriaxone, cefixime and azithromycin. We conducted investigations among cases and partners, identifying >100 new GC cases. Finally, we merged epidemiologic and partner data with isolate genomic data to further explore sexual networks with GC transmission and identify opportunities for local interventions. Innovation and Significance SURRG successfully built clinic, laboratory, and epidemiological capacity for local ARGC rapid detection and response. Notable outcomes/innovations include establishing best practices for collecting and transporting gonococcal culture specimens, implementing Etest® in local jurisdictions, and measuring the value of containing ARGC spread through partner services. Lessons learned and project-informed identification of additional ARGC control needs at the local and national level are being used to inform CDC’s ongoing ARGC control efforts.