Tetracycline Resistance Among Neisseria gonorrhoeae Isolates-United States, 1987-2022

Doxycycline use in sexually transmitted infection (STI) care is changing. Concerns about antimicrobial resistance (AR) have accompanied recent recommendations for doxycycline as bacterial STI postexposure prophylaxis (doxy PEP). We describe trends in tetracycline resistance (TetR) among Neisseria gonorrhoeae (GC) isolates collected through US national surveillance in anticipation of expanded use of doxy PEP.

N. gonorrhoeae isolates were collected from men with symptomatic urethritis attending Gonococcal Isolate Surveillance Project (GISP) clinics during 1987-2022 or from patients diagnosed with gonorrhea attending GISP, enhanced GISP, and/or Strengthening the US Response to Resistant Gonorrhea clinics during 2018-2022. Antimicrobial susceptibility testing was performed using agar dilution. We describe TetR (tetracycline minimum inhibitory concentration (MIC) ≥2 μg/mL) and high-level TetR (TetHLR) (MIC ≥16 μg/mL) patterns among collected GC isolates, including by sex and sex of sex partner(s).

A total of 183,668 urethral GC isolates were collected from men with symptomatic urethritis during 1987-2022. The proportion of isolates demonstrating TetR was stable during 1987 (19.7%) to 2022 (19.7%) though isolates demonstrating TetHLR increased from 2.8% to 14.6%. A total of 38,383 GC isolates were collected from patients with gonorrhea during 2018-2022; TetHLR increased across all sex/sex of sex partner(s) groups and was highest among men reporting male sex partner(s).

An increasing proportion of GC isolates collected through US national surveillance are demonstrating TetHLR. As doxycycline use expands in STI care, enhanced surveillance will be needed to monitor downstream impacts of its use on antimicrobial-resistant GC.