Implementation, Feasibility and Acceptability of Reflex Molecular Antibiotic Resistance Testing for Treatment Diversification of N. gonorrhoeae in a Sexual Health Clinic

Background: Resistance-guided treatment has the potential to expand treatment options for Neisseria gonorrhoeae (NG) and may be useful as an antimicrobial stewardship strategy. Methods: The study enrolled asymptomatic patients undergoing NG testing at a sexual health clinic in Seattle, WA, USA, March 2022-July 2024. Specimens that tested positive for NG using the Aptima Combo 2 assay were then tested using the SpeeDx PlexPrime® GC+gyrA (RUO) assay, which detects gyrA S91 (wild type) and gyrA S91F (mutant). We offered patients with gyrA S91 NG treatment with ciprofloxacin and treated participants with the gyrA S91F mutation or indeterminate gyrA results with ceftriaxone. NG positive participants were asked to return for a test of cure 14 days (+/-2) following treatment. Results: Sixty-two (5%) of 1,215 participants tested NG positive; 22 (36%) had gyrA wild type (S91), 28 (45%) had the gyrA S91F mutation, and 12 (19%) were indeterminate. Sixteen (73%) of the 22 participants with gyrA wild type (S91) received ciprofloxacin. All participants treated with ciprofloxacin had negative NG tests of cure. Mean time to reflexed gyrA test result was 2.8 days (SD=0.9 days). Among 17 survey persons treated with ciprofloxacin, 78% indicated that waiting an extra day for test results was worth it to avoid an injection while the remaining respondents were neutral. Conclusion: Reflex molecular testing for quinolone susceptibility allowed 26% of patients with NG to be successfully treated with ciprofloxacin. Participants treated with ciprofloxacin believed that reflex testing was beneficial.