Impact of Anatomic Site, Specimen Collection Timing, and Patient Symptom Status on Neisseria gonorrhoeae Culture Recovery

Abstract

Background: Neisseria gonorrhoeae culture is required for antimicrobial susceptibility testing, but recovering isolates from clinical specimens is challenging. Although many variables influence culture recovery, studies evaluating the impact of culture specimen collection timing and patient symptom status are limited. This study analyzed urogenital and extragenital culture recovery data from Centers for Disease Control and Prevention's Strengthening the US Response to Resistant Gonorrhea (SURRG) program, a multisite project, which enhances local N. gonorrhoeae culture and antimicrobial susceptibility testing capacity.Methods: Eight SURRG jurisdictions collected gonococcal cultures from patients with N. gonorrhoeae-positive nucleic acid amplification test (NAAT) results attending sexually transmitted disease and community clinics. Matched NAAT and culture specimens from the same anatomic site were collected, and culture recovery was assessed. Time between NAAT and culture specimen collection was categorized as same day, 1 to 7 days, 8 to 14 days, or ≥15 days, and patient symptoms were matched to the anatomic site where culture specimens were collected.Results: From 2018 to 2019, among persons with N. gonorrhoeae-positive NAAT, urethral infections resulted in the highest culture recovery (5927 of 6515 [91.0%]), followed by endocervical (222 of 363 [61.2%]), vaginal (63 of 133 [47.4%]), rectal (1117 of 2805 [39.8%]), and pharyngeal (1019 of 3678 [27.7%]) infections. Culture recovery was highest when specimens were collected on the same day as NAAT specimens and significantly decreased after 7 days. Symptoms were significantly associated with culture recovery at urethral ( P = <0.0001) and rectal ( P = <0.0001) sites of infection but not endocervical, vaginal, or pharyngeal sites.Conclusions: Culture specimen collection timing and patient symptomatic status can impact culture recovery. These findings can guide decisions about culture collection protocols to maximize culture recovery and strengthen detection of antimicrobial-resistant infections.

Neisseria gonorrhoeae culture growth rates from asymptomatic individuals with a positive nucleic acid amplification test

“…2020; Nash et al . 2021). In our study, as shown in Table 2, the most common site of infection was the pharynx (71·3%; 95% CI 68·0–74·6), followed by rectum (42·8%, 95% CI 39·1–46·2) and genitals (10·9%, 95% CI 8·6–13·2).…”

Strengthening the US Response to Resistant Gonorrhea: An Overview of a Multisite Program to Enhance Local Response Capacity for Antibiotic-Resistant Neisseria gonorrhoeae

“…Culture success by anatomic site among NAATpositive patients in SURRG is reported elsewhere. 20 Of isolates that underwent AST (99.3% of positive cultures), 11% demonstrated azithromycin nonsusceptibility; fewer than 0.5% demonstrated elevated ceftriaxone or cefixime MICs (Table 2).…”

New Evidence for Antimicrobial-Resistant Gonorrhea Control Programs: Lessons Learned from the SURRG Project

“…As expected, urethral specimens yielded positive GC cultures greater than 90% of the time and endocervical/vaginal 55%, but pharyngeal culture was even poorer than previously documented 16 : only 28% of specimens collected from a NAAT-positive individual resulted in a GC isolate. 15 Culture recovery declined in the time between NAAT collection and culture collection for all anatomic sites. These data can help refine clinical criteria for when to obtain specimens and serve as an impetus to find ways to improve isolate recovery from extragenital sites in SURRG cycle 2.…”