(P46) WHAT CAN ENHANCED GONORRHEA SURVEILLANCE TELL US ABOUT EXTRAGENITAL EXPOSURES AND SYMPTOMS? FINDINGS FROM VIRGINIA, 2021-2023

Background:
Extragenital screening for gonorrhea has become more routine in recent years, but corresponding information on sexual exposures and symptomology is often lacking outside of clinic-based studies. We sought to use population-based surveillance data to characterize the experiences of persons recently diagnosed with gonorrhea.

Methods:
From 2021 to 2023, we conducted enhanced patient and provider follow-up for a random sample of adult gonorrhea cases. Cases were sampled from an annually rotating selection of Virginia districts based on greatest relative morbidity burden. Phone-based patient interviews followed a standardized script with opportunities for counseling, education, and referrals. We performed descriptive analyses stratified by patient sex and gender of sex partners. For this assessment, we focused on patient-reported extragenital exposures, symptoms, and associated positive tests.

Results:
We analyzed data for 649 patient interviews conducted from 2021 to 2023 (8% of 8,469 gonorrhea diagnoses). Multiple types of sex exposures were common; 69% (193/278) of women, 81% (171/211) of men who reported sex with women (MSW), and 95% (138/145) of men who reported sex with men (MSM) reported extragenital exposure. Overall, 77% reported symptoms. Rectal symptoms were reported by 5% of women, 6% of MSW, and 12% of MSM; pharyngeal symptoms were reported by 12%, 7%, and 17%, respectively. Thirteen percent of patients who reported anal or oral sex also reported corresponding rectal or pharyngeal symptoms. Nine percent of patients were positive rectally, while 14% had a positive pharyngeal test. Of 58 patients who tested positive rectally, 19% reported rectal symptoms; 25% of 92 patients with positive pharyngeal tests reported pharyngeal symptoms.

Conclusion:
Information obtained through passive surveillance of gonorrhea is often insufficient to inform programmatic prevention efforts. Targeted enhanced surveillance can supplement routinely captured data with more detailed demographic, behavioral, and clinical information to assess extragenital exposure and testing trends and contribute to improved understanding of infection dynamics.