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Quinolone-Resistant Gonorrhea Emerging in U.S..

During the last 20 years, the gonococcus has evolved significant resistance first to the penicillins, then to the tetracyclines. Now the quinolones seem to be losing ground, with quinolone-resistant gonorrhea common in some parts of Asia and slowly emerging in the U.S.

Two cases of urethral gonorrhea with significant quinolone resistance were reported to the CDC from San Diego in 1997. Both occurred in young heterosexual men, with no epidemiologic link to each other and no recent travel to Asia. Both patients were initially treated with standard regimens of ofloxacin and doxycycline for possible chlamydia coinfection. One did not respond to treatment and required retreatment with ceftriaxone, while the other responded both clinically and microbiologically, possibly because his isolate retained some susceptibility to the tetracyclines. No transmission of the resistant isolates to sexual partners occurred.

Comment: Quinolone-resistant gonorrhea is still quite rare in the U.S., but some pockets of local prevalence are beginning to appear. This trend is of particular concern because of the growing popularity of rapid nonculture methods of diagnosing gonorrhea in this country. Patients with apparent treatment failure to quinolone regimens should always be evaluated with standard culture techniques, both to guide further treatment and to track this new pattern of antibiotic resistance.

— A Zuger

Published in Journal Watch General Medicine June 5, 1998

Citation(s):

Fluoroquinolone-resistant Neisseria gonorrhoeae -- San Diego, California, 1997. MMWR Morb Mortal Wkly Rep 1998 May 29 47 405-408.

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