Communicable Diseases

Antibiotic resistance is bacteria’s ability to resist the effects of the drugs used to treat them. Gonorrhea has developed resistance to nearly all the antibiotics used for its treatment. We are currently down to one class of antibiotics, cephalosporins, to treat this common infection. The risk of antibiotic-resistant gonorrhea developing is now considered to one of most urgent public health threats in the United States. 

The Guilford County Division of Public Health laboratory is one of several labs across the nation that is conducting surveillance for resistant gonorrhea by participating in the Combatting Antimicrobial Resistant Gonorrhea and Other STIs (CARGOS) project.  Below are resources for healthcare providers who suspect they have an individual with possible gonorrhea antibiotic resistance.

Potential Treatment Failure

Clinicians are asked to report any gonorrhea specimen with decreased cephalosporin susceptibility and any gonorrhea cephalosporin treatment failure to the Guilford County Division of Public Health, using the online Communicable Disease Reporting tool as soon as possible after receiving a positive result for a repeat NAAT, or upon receipt of a positive culture test (assuming reinfection is unlikely). Staff can coordinate culture and AST testing and will refer information to a Disease Intervention Specialist (DIS) who will contact the patient for additional follow-up for additional vital information. Find guidance regarding suspected gonorrhea treatment failures.

Request for Neisseria gonorrhoeae (GC) culture and/or Antimicrobial Susceptibility Testing (AST)

Specimens can be sent to Guilford County for antimicrobial susceptibility testing (AST) from entities both inside and outside of Guilford County’s jurisdiction when there is a suspect antimicrobial resistance to treatment or in the case of a suspected disseminated gonococcal infection (DGI). Download a Lab Request Form with instructions.

Additional information about gonorrhea in North Carolina can be found on the NC Gonorrhea Center of Excellence web page.

1. Alert Guilford County’s SURRG Lab at 336-641-6823 (if unable to reach anyone in the SURRG lab, contact Guilford County’s Main lab at 336-641-6602) that you are sending a specimen for AST. Provide the shipping provider’s name, the specimen’s tracking number, and the estimated time the shipment should arrive. Do not send any specimens on Fridays, over the weekend, or the day before a state holiday. Specimens must arrive in Guilford County, Monday through Friday, between 8 a.m. to 5 p.m.
2. Isolates can be sent ambient on Chocolate slants or on GC selective media such as GC-Lect, MTM agar or Chocolate II plates. InTrays and Jembec collection systems are also acceptable. Tubes/media must be sealed with tape and placed in a leak-proof container before shipping to help preserve organism viability. If there is a question if the specimen(s) will reach Guilford County within 48 hours of plating, the isolates can be sent frozen, using dry ice, in trypticase soy broth (TSB) with 20% glycerol.
3. Isolates must be fresh growth (24 to 48 hours old). If culture plates are >48 hours old, they must be subcultured, incubated, and sent once fresh growth is present.
4. All specimens must be labeled with the patient’s name, date of birth, and the specimen source.
5. The sample must be accompanied by a Guilford County AST Lab Request. The information on the label must match the information on the AST Lab Request Form. Provide as much information as possible when completing the form. A contact name and number must be provided so that results can be communicated in a timely manner.
6. If the specimen(s) are suspected of disseminated gonococcal infections (DGI), this must be indicated on the form where indicated.