Core group dynamics of gonorrhea infection in a North Carolina county from 2018 to 2023

BackgroundCore groups, characterized by high levels of sexual activity and disease prevalence, are critical to the transmission dynamics of sexually transmitted infections (STIs) like gonorrhea. Understanding core group dynamics is essential for developing targeted interventions and understanding their potential effect on outcomes for gonorrhea. We assessed core group composition among gonorrhea cases in Guilford County, North Carolina, where gonorrhea rates are elevated, and antimicrobial resistance is a growing concern. MethodsWe used Neisseria gonorrhoeae surveillance data collected in both public health clinics and emergency departments in Guilford County to characterize core groups. Data including demographics, behavioral risks, and longitudinal gonorrhea test results, were reviewed for specimens submitted for gonorrhea testing. Statistical analyses, including descriptive statistics and univariate logistic regression, were performed to assess factors influencing core group membership within three subpopulations: teens, adult men who have sex with men (MSM), and adult heterosexuals. ResultsThe study included 25,520 patients, with 1,718 (6.7%) classified as part of the core group. The core group accounted for 68% of all gonorrhea cases, with subgroups such as teen, adult MSM, and adult heterosexual core groups contributing disproportionately to their respective gonorrhea cases (66%, 79%, and 67%, respectively). Demographic and behavioral risk factors are explored and factors increasing odds ratios of core group inclusion are identified among the general population as well as three subpopulations: teens, adult MSM, and adult heterosexual core groups. Notable risk factors for gonorrhea core group inclusion across all subgroups include increased number of sexual partners, drug use, and HIV status. Notably, there is variation in some risk factors among subpopulations including race/ethnicity and sex while traveling internationally. DiscussionAmong other factors, variations in public health policies and population level behavioral norms change the way gonorrhea spreads through a population. We report gonorrhea core group composition for a region with high gonorrhea rates. In particular, we discuss the role of teenagers in gonorrhea transmission dynamics, a typically under reported group. Understanding population specific dynamics is essential for formulating effective and targeted interventions.