Gonorrhea Treatment Failure: New Susceptibility Testing Service Available
September 11, 2021
Antibiotic-resistant Neisseria gonorrhoeae has been identified in the United States and in Orange County. The medical and public health communities need to prepare for management of infections. If you have reasonable concern of gonococcal treatment failure, susceptibility testing is available to support medical management as well as public health surveillance for resistant organisms. As part of the CDC’s Antibiotic Resistance Lab Network (ARLN), the Maryland Public Health Laboratory (MDPHL) will perform susceptibility testing. Treatment failure should be considered in persons whose symptoms do not resolve in 3-5 days after appropriate treatment and report no sexual contact during the post-treatment follow-up period and in persons with a positive test-of-cure, meaning positive culture >/=72 hours or positive NAAT >/=10-14 days after receiving recommended treatment.


Orange County Public Health Laboratory (OCPHL) will forward specimens from suspected gonococcal treatment failure to the Maryland Public Health Laboratory on behalf of the requesting physician. Isolates will be tested for susceptibility to azithromycin, cefixime, and ceftriaxone and results returned to submitters within 6-10 days of receipt at MDPHL. More information can be found here: https://health.maryland.gov/laboratories/Pages/ARLNHome.aspx. 
Acceptable Specimens:
  • Pure frozen or lyophilized isolates of either confirmed or suspected Neisseria gonorrhoeae. 
  • Confirmed or suspected N. gonorrhoeae grown in pure culture on media (e.g. Choc II slants or BHI slants). 
  • Clinical samples collected directly from patient and inoculated onto transport media. GC Intray Collection Kits may be requested directly from the Maryland Department of Health using this link: https://health.maryland.gov/laboratories/docs/ARLN_SupplyRequest.pdf

Acceptable specimen sources are blood, conjunctival, endocervical, pharyngeal, rectal, urethral, urine, synovial fluid, and vaginal specimens.
Additional Information:
Prior to sending a specimen to the MD ARLN, submitters must complete the GC Etest Authorization Form and submit the via email to mdphl.arln@maryland.gov with subject line “GC Etest Request.” If the request is approved, additional guidance will be provided for specimen submission.

If the specimen is authorized, two forms must be included with the specimen when submitted to OCPHL:
  1. OCPHL Test request form: must accompany the isolate/specimen with the required patient information and a note written on the bottom of the form indicating “suspected gonococcal treatment failure, send to ARLN for susceptibility testing”. The isolate/specimen must have a minimum of two unique patient identifiers and the date of specimen collection.
  2. Maryland Department of Health Infectious Agents: Culture/Detection form: All highlighted fields must be filled out, including submitter name and address, contact information, the ordering physician (Test Request Authorized by), patient information, date and time collected, and specimen source.

If you have any questions regarding gonorrhea testing or treatment,
please call Christopher Ried, MD, Medical Director HIV/STD Service for the Orange County Health Care Agency, (714) 834-8598. 
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