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Since 2009, rates of gonorrhea have been increasing in the United States. Rates vary across sexual behavior groups and races/ethnicities. However, we don’t know how often Neisseria gonorrhoeae strains transmit between groups or how antibiotic resistance contributes to transmission in these groups. To better understand gonorrhea transmission, we studied N. gonorrhoeae in New York City using genomic epidemiology.

We sequenced 897 genomes from N. gonorrhoeae isolated from samples collected at NYC Department of Health and Mental Hygiene (DOHMH) Sexual Health Clinics. We analyzed this data together with demographic/clinical information and MICs measured at NYC DOHMH Public Health Laboratory. The NYC N. gonorrhoeae population is a microcosm of the global population. When we compared the NYC collection to our global genomic collection from our GWAS studies, we found that 22/23 common BAPS groups were found in NYC. The NYC N. gonorrhoeae population was structured by sexual behavior and race/ethnicity. We found that lineages A and B (first described in a global dataset) were associated with men who have sex with men (MSM) and heterosexuals, respectively. Isolates from MSM and white heterosexuals had higher MICs for ceftriaxone, azithromycin, and ciprofloxacin. These differences can be explained by differences in MICs in isolates from the multi-drug resistant lineage A compared to mostly susceptible lineage B. Also, while the overall population was structured by patient sexual behavior and race/ethnicity, the largest transmission clusters contained isolates sampled from patients across groups, echoing observations of bridging in other studies. While risk for resistance varied across patient groups, we found that these clusters were comprised of susceptible isolates, suggesting that antibiotic resistance was not the main driver of transmission of gonorrhea during the study period.

This advance access version of the manuscript is now available in Clinical Infectious Diseases. Check it out here!