Antibiotic-Resistant Neisseria gonorrhoeae: The Calm before Another Storm?
Authors: Hunter H. Handsfield
Journal: Annals of Internal Medicine (1996)

Editorials15 September 1996Antibiotic-Resistant Neisseria gonorrhoeae: The Calm before Another Storm?Hunter H. Handsfield, MD and William L. Whittington, MPHHunter H. Handsfield, MDSeattle-King County Department of Public Health University of Washington School of Medicine Seattle, WA 98104Search for more papers by this author and William L. Whittington, MPHSeattle-King County Department of Public Health University of Washington School of Medicine Seattle, WA 98104Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-125-6-199609150-00013 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Since the beginning of the modern chemotherapeutic era, the treatment of gonorrhea has been dogged by the shifting antimicrobial susceptibility of Neisseria gonorrhoeae. The sulfonamides, penicillins, tetracyclines, and erythromycin all fell by the wayside as strains of N. gonorrhoeae with relative or absolute resistance to antimicrobial agents evolved and spread; by 1988, approximately one third of all gonococcal isolates in the United States had one form of resistance or another [1, 2]. This led the Centers for Disease Control and Prevention (CDC) to recommend single-dose therapy with a broad-spectrum cephalosporin (cefixime or ceftriaxone) or a fluoroquinolone (ciprofloxacin or ofloxacin) for ...References1. Whittington WL, Knapp JS. Trends in resistance of Neisseria gonorrhoeae to antimicrobial agents in the United States. Sex Transm Dis. 1988; 15:202-10. Google Scholar2. Schwarcz SK, Zenilman JM, Schnell D, Knapp JS, Hook EW 3d, Thompson S, et al. National surveillance of antimicrobial resistance in Neisseria gonorrhoeae. The Gonococcal Isolate Surveillance Project. JAMA. 1990; 264: 1413-7. Google Scholar3. 1993 sexually transmitted diseases treatment guidelines. MMWR Morb Mortal Wkly Rep. 1993; 42(RR-14):57-67. Google Scholar4. Moran JS, Levine WC. Drugs of choice for the treatment of uncomplicated gonococcal infections. Clin Infect Dis. 1995; 20(Suppl 1):547-65. Google Scholar5. Neill MA, Opal SM, Heelan J, Giusti R, Cassidy JE, White R, et al. Failure of ciprofloxacin to eradicate convalescent fecal excretion after acute salmonellosis: experience during an outbreak in health care workers. Ann Intern Med. 1991; 114:195-9. Google Scholar6. Dornbusch K. Resistance to β-lactam antibiotics and ciprofloxacin in gram-negative bacilli and staphylococci isolated from blood: a European collaborative study. European Study Group on Antibiotic Resistance. J Antimicrob Chemother. 1990; 26:269-78. Google Scholar7. Gransden WR, Warren CA, Phillips I, Hodges M, Barlow D. Decreased susceptibility of Neisseria gonorrhoeae to ciprofloxacin [Letter]. Lancet. 1990; 335:51. 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Tapsall JW, Shultz TR, Lovett R, Munro R. Failure of 500 mg ciprofloxacin therapy in male urethral gonorrhea [Letter]. Med J Aust. 1992; 156:143. Google Scholar13. Birley H, McDonald P, Carey P, Fletcher J. High-level ciprofloxacin resistance in Neisseria gonorrhoeae [Letter]. Genitourin Med. 1994; 70:292-3. Google Scholar14. Gordon SM, Carlyn CJ, Doyle LJ, Knapp CC, Longworth DL, Hall GS, et al. The emergence of Neisseria gonorrhoeae with decreased susceptibility to ciprofloxacin in Cleveland, Ohio: epidemiology and risk factors. Ann Intern Med. 1996; 125:465-70. Google Scholar15. Knapp JS, Washington JA, Doyle LJ, Neal SW, Parekh MC, Rice RJ. Persistence of Neisseria gonorrhoeae strains with decreased susceptibilities to ciprofloxacin and ofloxacin in Cleveland, Ohio, from 1992 through 1993. Antimicrob Agents Chemother. 1994; 38:2194-6. Google Scholar16. Belland RJ, Morrison SG, Ison C, Huang WM. Neisseria gonorrhoeae acquires mutations in analogous regions of gyrA and parC in fluoroquinolone-resistant isolates. Mol Microbiol. 1994; 14:371-80. Google Scholar17. Handsfield HH, Sandstrom EG, Knapp JS, Perine PL, Whittington WL, Sayers DE, et al. Epidemiology of penicillinase-producing Neisseria gonorrhoeae infections: analysis by auxotyping and serogrouping. N Engl J Med. 1982; 306:950-4. Google Scholar18. U.S. Department of Health and Human Services, Public Health Service, Division of STD Prevention. Sexually Transmitted Disease Surveillance, 1994. Atlanta: Centers for Disease Control and Prevention; 1995:5-17. Google Scholar19. Echols RM, Heyd A, O'Keeffe BJ, Schacht P. Single-dose ciprofloxacin for the treatment of uncomplicated gonorrhea: a worldwide summary. Sex Transm Dis. 1994; 21:345-52. Google Scholar Author, Article, and Disclosure InformationAffiliations: Seattle-King County Department of Public Health University of Washington School of Medicine Seattle, WA 98104 PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoThe Emergence of Neisseria gonorrhoeae with Decreased Susceptibility to Ciprofloxacin in Cleveland, Ohio: Epidemiology and Risk Factors Steven M. Gordon , Cynthia J. Carlyn , Laura J. Doyle , Cynthia C. Knapp , David L. Longworth , Geraldine S. Hall , and John A. 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