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No More Cipro for Gay Men with Gonorrhea

Quinolone-resistant gonorrhea has reached a tipping point among men who have sex with men.

Quinolone-resistant gonorrhea was first reported in the U.S. in 1998 (Journal Watch Jun 5 1998). By 2002, it had become common enough in California and Hawaii for the CDC to recommend against using quinolones to treat patients with gonorrhea acquired in these states (Journal Watch Dec 24 2002). The frequency of quinolone-resistant gonorrhea has now reached the same tipping point nationally among men who have sex with men (MSM).

A CDC-sponsored nationwide surveillance system annually monitors drug susceptibilities of about 5000 gonococcal isolates obtained from men with the disease at 30 STD clinics. The overall prevalence of quinolone resistance rose from 0.7% in 2001 to 2.2% in 2002 to 4.2% in 2003. Among MSM, the 2003 prevalence was 4.9% (up from 1.8% in 2002); among heterosexual men, it was 0.4%. Closer evaluation in 2003 of gonorrhea patients in STD clinics in Massachusetts and New York found that quinolone resistance was present in 5% to 10% of cases from whom cultures were taken; nearly all resistant infections were in MSM.

Comment: Quinolone treatment of gonorrhea is popular for its one-dose convenience, particularly because the recommended alternative is intramuscular ceftriaxone. However, clinicians should be aware of the unacceptably high possibility of failure in MSM. If absolutely unavoidable, quinolones should be given to MSM only if cultures are taken and patients can be recalled if treatment fails. At the time of publication, the full text of the original article was available free of charge.

— Abigail Zuger, MD

Published in Journal Watch General Medicine May 11, 2004

Citation(s):

Centers for Disease Control and Prevention (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 Morb Mortal Wkly Rep 2004 Apr 30; 53:335-8.

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