Neisseria gonorrhoeae Antimicrobial Resistance Among Men Who Have Sex With Men and Men Who Have Sex Exclusively With Women: The Gonococcal Isolate Surveillance Project, 2005–2010

University of Alabama at Birmingham, Birmingham, Alabama, United States
Annals of internal medicine (Impact Factor: 17.81). 03/2013; 158(5 Pt 1):321-8. DOI: 10.7326/0003-4819-158-5-201303050-00004
Source: PubMed


Chinese translation
Gonorrhea treatment has been complicated by antimicrobial resistance in Neisseria gonorrhoeae. Gonococcal fluoroquinolone resistance emerged more rapidly among men who have sex with men (MSM) than men who have sex exclusively with women (MSW).
To determine whether N. gonorrhoeae urethral isolates from MSM were more likely than isolates from MSW to exhibit resistance to or elevated minimum inhibitory concentrations (MICs) of antimicrobials used to treat gonorrhea.
6 years of surveillance data from the Gonococcal Isolate Surveillance Project.
Publicly funded sexually transmitted disease clinics in 30 U.S. cities.
Men with a total of 34 600 episodes of symptomatic urethral gonorrhea.
Percentage of isolates exhibiting resistance or elevated MICs and adjusted odds ratios for resistance or elevated MICs among isolates from MSM compared with isolates from MSW.
In all U.S. regions except the West, isolates from MSM were significantly more likely to exhibit elevated MICs of ceftriaxone and azithromycin than isolates from MSW (P < 0.050). Isolates from MSM had a high prevalence of resistance to ciprofloxacin, penicillin, and tetracycline and were significantly more likely to exhibit antimicrobial resistance than isolates from MSW (P < 0.001).
Sentinel surveillance may not be representative of all patients with gonorrhea. HIV status, travel history, and antimicrobial use data were missing for some patients.
Men who have sex with men are vulnerable to the emerging threat of antimicrobial-resistant N. gonorrhoeae. Because antimicrobial susceptibility testing is not routinely done in clinical practice, clinicians should monitor for treatment failures among MSM diagnosed with gonorrhea. Strengthened prevention strategies for MSM and new antimicrobial treatment options are needed.
Centers for Disease Control and Prevention.

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Available from: Robert D Kirkcaldy
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    • "We used antimicrobial drug susceptibility data from the Gonococcal Isolate Surveillance Project (GISP) to analyze the association between ciprofloxacin resistance and gonorrhea incidence over time at the city level. GISP has been described in detail by Schwarcz et al. (11) and Kirkcaldy et al. (12). In brief, GISP is a sentinel surveillance system established in 1986 to monitor antimicrobial drug susceptibility among N. gonorrhoeae isolates. "
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    ABSTRACT: Antimicrobial drug resistance can hinder gonorrhea prevention and control efforts. In this study, we analyzed historical ciprofloxacin resistance data and gonorrhea incidence data to examine the possible effect of antimicrobial drug resistance on gonorrhea incidence at the population level. We analyzed data from the Gonococcal Isolate Surveillance Project and city-level gonorrhea incidence rates from surveillance data for 17 cities during 1991-2006. We found a strong positive association between ciprofloxacin resistance and gonorrhea incidence rates at the city level during this period. Their association was consistent with predictions of mathematical models in which resistance to treatment can increase gonorrhea incidence rates through factors such as increased duration of infection. These findings highlight the possibility of future increases in gonorrhea incidence caused by emerging cephalosporin resistance.
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