(Washington, DC) In the last 12 months, three cases of quinolone-resistant Neisseria gonorrhoeae (QRNG) have been reported to the District of Columbia Department of Health (DOH) Sexually Transmitted Disease Control Program by local health care providers serving men who have sex with men (MSM).
QRNG is defined as N. gonorrhoeae resistant to ciprofloxacin or ofloxacin by the National Committee on Clinical Laboratory Standards. Ciprofloxacin or ofloxacin has been the preferred method of treating N. gonorrhoeae because it is an inexpensive, oral, and single-dose therapy. QRNG is common in parts of Asia (where QRNG prevalence exceeds 40%), Hawaii, and California. Sporadic cases of QRNG have been reported throughout the United States. Based on data from sentinel sites such as New York City and Massachusetts, the prevalence of QRNG among MSM is now >5% (CDC. Increases in Fluoroquinolone-Resistant Neisseria gonorrhoeae Among Men Who Have Sex with Men United States, 2003, and Revised Recommendations for Gonorrhea Treatment, 2004. MMWR 2004;53 (16);335-338).
As a result of these three local cases, and based on recommendations by the Centers for Disease Control and Prevention, the STD Control Program advises local health care providers to elicit a thorough history on all suspected and confirmed gonorrhea cases, especially regarding recent travel and sexual partners. Quinolones should not be used to treat gonococcal infections acquired in Asia; in the Pacific Islands, including Hawaii; and in California. Quinolones should also not be used to treat gonococcal infections in MSM.
NON-QUINOLONE GONORRHEA TREATMENT OPTIONS
- Ceftriaxone 125 mg intramuscularly (IM) in a single dose
- Cefixime 400 mg orally in a single dose (currently not available in the United States)
- Spectinomycin 2 grams intramuscularly (IM) in a single dose
The emergence of QRNG in Hawaii, California, and among MSM highlights the ongoing need for monitoring antimicrobial susceptibilities of gonococcal isolates throughout the United States. Because symptomatic treatment failures are not a reliable indicator of emerging antimicrobial resistance, the STD Control Program advises local health care providers to perform culture and antimicrobial susceptibility testing on all cases where gonococcal infection persists after treatment. The antimicrobial susceptibility testing panel should, at a minimum, include a quinolone, cefixime, ceftriaxone, spectinomycin, and azithromycin.
As part of effective gonorrhea control, local gonococcal antimicrobial susceptibility prevalence needs to be monitored in order to assist in developing local treatment recommendations. Please report all QRNG cases to the STD Control Program at (202) 727-9863 or (202) 727-9864.