Epidemiology of Antimicrobial Resistant Gonococcal Infection (ARGC) in King County, Washington
Figure 1: Gonorrhea diagnoses increased steadily in Washington State and in King County from 2011 to 2019. In 2020, the number of diagnosed cases decreased slightly, although it’s unclear whether this was due to a change in STD testing practices caused by the COVID-19 pandemic or a true decrease in incidence. From 2020 to 2024, the number of annual diagnoses has remained relatively stable. There were 9,797 gonorrhea diagnoses in Washington State in 2023, and 4,366 gonorrhea diagnoses in King County in 2024.
Figure 2: CDC’s Gonococcal Isolate Surveillance Project (GISP) monitors antimicrobial resistance in urethral gonococcal isolates from STD clinics around the U.S. In King County, azithromycin reduced susceptibility was low between 2009 and 2013 (0-1%), increased sharply in 2014 to 5%, then has increased steadily through 2023 to a high of 14%. Cephalosporin reduced susceptibility was low between 2009 and 2013 (0-1%), increased to 4% during 2015-2016, then decreased again during 2017-2023 (0-1%).
Figure 3: CDC’s Strengthening the U.S. Response to Resistant Gonorrhea (SURRG, 2017-2024) and Combatting Antimicrobial Resistant Gonorrhea and Other STIs (CARGOS, 2024-present) monitor ARGC in patients of all genders with Neisseria gonorrhoeae (NG) and at any infected anatomic site. Differences in ARGC may be observed when comparing men who have sex with men (MSM) vs. heterosexual men and women. In King County, reduced susceptibility to cephalosporins (ceftriaxone and cefixime) has been low, 0-1% annually between 2017 and 2024, and has been detected in both MSM and heterosexuals.
Figure 4: The proportion of gonococcal isolates with reduced susceptibility to cephalosporins (ceftriaxone and cefixime) increased among all anatomic sites from 2017 (0%) to 2019 (1.5% at the pharynx, 1.3% at the rectum, and 1.0% at the genitals) and decreased back to 0% in 2021. In 2022 and 2023, 0.7% of pharyngeal isolates had reduced susceptibility to cephalosporins, while genital and rectal isolates remained at 0%.
Figure 5: Public Health – Seattle & King County (PHSKC) partnered with several healthcare clinics in King County to collect gonococcal isolates from patients beyond the traditional STD clinic setting for monitoring ARGC from 2017 to 2024. About 15% of NG patient-cases with susceptibility screening in King County were diagnosed at community clinics. Cephalosporin reduced susceptibility was highest in 2019 (1% at the PHSKC Sexual Health Clinic and 3% in community partner clinics) but has remained low (<1% at both types of sites) since 2020.