Before 2003, only sporadic cases of QRNG were detected in Michigan; all of these patients acquired their infections during foreign travel.
After the identification of QRNG cases, surveillance was expanded to include 4 additional STD clinics in 4 counties (Table 1).
Patients with QRNG were interviewed (by phone or in person) by MDCH disease intervention specialists, and additional information was collected, including that on illicit drug use, recent use of antimicrobial agents, sexual partner risk factors, HIV status, and travel history.
Patient and specimen characteristics for QRNG and non-QRNG isolates are shown in Table 2, stratified by year.
All 8 cases of QRNG detected in the 2004 study period were in MSM.
Although 35% of isolates were submitted by private providers, only 23% of QRNG cases were identified through those venues.
Although most persons with gonorrhea in our sentinel surveillance system are African American (76% of those with known race), the prevalence of QRNG was higher among whites, 7% versus 1% among non-whites.
Michigan has seen a higher prevalence of QRNG in recent years among heterosexuals, especially men in county A (3.
A quick response to this geographic cluster may have halted the spread of QRNG in the community.
However, QRNG surveillance is limited and not optimally representative: during the study period, it only operated in 9 of Michigan's 83 counties.