North Carolina and Guilford County has experienced an increase in reported gonorrhea cases in recent years. Gonococcal infections is the cause of several inflammatory conditions such as urethritis, cervicitis, and proctitis in adults, vulvo-vaginitis in children, and opthalmia in newborns.  The most common infection is gonorrhea of the urogenital tract.  Nationally there has also been an increase in number of cases of disseminated gonococcal infections (DGI).  DGI occurs when the sexually transmitted pathogen Neisseria gonorrhoeae invades the bloodstream and spreads to distant sites in the body, leading to clinical findings such as septic arthritis, polyarthralgia, tenosynovitis, petechial/pustular skin lesions, bacteremia, or, on rare occasions, endocarditis or meningitis.  DGI is uncommon and thought to occur in 0.5-3% of untreated gonorrhea cases. Cultures from disseminated sites of infection are often negative and mucosal sites of infection (e.g. urogenital, rectal, or pharyngeal) are often asymptomatic and not tested before empiric antimicrobial treatment is started despite having a higher diagnostic yield.  As a result, DGI is usually a clinical diagnosis without microbiologic confirmation, which likely contributes to underdiagnosis and treatment delays.

Guilford County DDHS Laboratory is one of several labs across the nation that is a part of the Strengthening the U.S. Response to Resistant Gonorrhea (SURRG) project.  SURRG is a network of CDC-supported jurisdictions that have enhanced capacity to rapidly detect and respond locally to gonococcal infections with reduced antimicrobial susceptibility. While the majority of the testing involves specimens collected within Guilford County’s jurisdiction, specimens can be sent to Guilford for antimicrobial susceptibility testing (AST) from entities outside of Guilford’s jurisdiction when there is a suspect antimicrobial resistance to treatment or in the case of suspected disseminated gonococcal infections (DGI).

Instructions for shipping DGI specimens to the Guilford County DHHS SURRG Lab For Neisseria gonorrhoeae (GC) Antimicrobial Susceptibility Testing (AST)

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 shipping provider’s name, the specimen’s tracking number and estimated time shipment should arrive. Do NOT send any specimens on Fridays, over the weekend, or the day before a State holiday. Specimens must arrive at Guilford County Monday – Friday during their operational hours of 8am and 5pm. 
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 patient’s name, date of birth and the specimen source.
5. Sample must be accompanied by a Guilford County AST Lab Request (Embed link to form here). Information on label must match information on the AST Lab Request Form. Provide as much information as possible when completing the form. It is critical that a contact name and number be provided so that results can be communicated in a timely manner. 
6. If the specimen(s) are suspected disseminated gonococcal infections (DGI), this must be indicated on the form where indicated.