King K. Holmes, MD, PhD
Professor, Department of Medicine & Department of Global Health
Director, Center for AIDS and STD
Chair, Department of Global Health
Head, Infectious Diseases
The laboratory has four major foci: (1) Antimicrobial susceptibility surveillance and outbreak investigation; (2) Strain characterization and pathogenesis studies; (3) Provision of the Neisseria Reference Laboratory strain collection to aid persons in training, other investigators and test developers in industry; (4) Evaluation of newly developed tests for infection with N. gonorrhoeae, C. trachomatis, and T. vaginalis and performance of nucleic acid amplification (NAAT) and other tests in support of epidemiologic studies; and (5) Reference activities in support of regional clinical laboratories. The laboratory participates in the CDC-supported Gonococcal Isolate Surveillance Project (GISP) as one of five regional laboratories. Agar dilution susceptibilities are performed monthly and strains of interest are further characterized. The laboratory provides leadership in such investigations as the contemporary outbreak of fluoroquinolone resistant gonorrhea in Seattle. Outbreak investigations aid in the generation of natural history and pathogenesis hypotheses. Molecular strain characterization studies include both procedures performed in the laboratory and collaborative studies resulting in specialized tests performed in the laboratories of other investigators. Contemporary research includes characterization of the lactoferrin (LF) and C4bp binding of gonococci that cause less apparent clinical disease in men, determination of macrolide resistance determinants in N. gonorrhoeae and N. meningitidis, and pulse field gel electrophoretic (PFGE) characterization of outbreak gonococcal strains to assess strain divergence over time. Components of the laboratory’s strain/clinical data collection are currently being used to: (a) describe the geographic and temporal spread of gonococcal phenotypes during a 10 year period in Seattle; (b) assess the impact of reinfection on gonococcal incidence; (c) reassess the role of porin serovar in gonococcal immunity; (d) further studies of the pathogenesis of disseminated gonococcal infection (DGI); and (e) provision of a panel of strains to aid in the development of the next generation of Roche’s gonococcal PCR assay. The laboratory has recently completed a trial of an immediate test for gonorrhea and chlamydial infection and a trial of an immediate test for T. vaginalis infection. Support of epidemiologic studies has included measures of inflammation in studies of HIV viral load in rectal secretions, development of gonococcal test medium, and the performance of NAAT in planned studies within the STD CRC.