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Original Research |

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

Robert D. Kirkcaldy, MD, MPH; Akbar Zaidi, PhD; Edward W. Hook III, MD; King K. Holmes, MD, PhD; Olusegun Soge, PhD; Carlos del Rio, MD; Geraldine Hall, PhD; John Papp, PhD; Gail Bolan, MD; and Hillard S. Weinstock, MD, MPH
[+] Article and Author Information

From the Centers for Disease Control and Prevention and Emory University, Atlanta, Georgia; University of Alabama and Jefferson County Department of Health, Birmingham, Alabama; University of Washington, Seattle, Washington; and Cleveland Clinic, Cleveland, Ohio.

Acknowledgment: The authors acknowledge Alesia Harvey, Tremeka Sanders, Kevin Pettus, Samera Bowers, Paula Dixon, Laura Doyle, Baderinwa Offut, and the GISP participating clinics.

Financial Support: By the Centers for Disease Control and Prevention.

Potential Conflicts of Interest: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M12-1430.

Reproducible Research Statement: Study protocol: Available at www.cdc.gov/std/gisp. Statistical code: Not available. Data set: Proposals for uses of GISP data should be submitted to Dr. Kirkcaldy (e-mail, rkirkcaldy@cdc.gov).

Requests for Single Reprints: Robert Kirkcaldy, MD, MPH, Centers for Disease Control and Prevention, 1600 Clifton Road, Mailstop E-02, Atlanta, GA 30333; e-mail, rkirkcaldy@cdc.gov.

Current Author Addresses: Drs. Kirkcaldy, Bolan, and Weinstock: Centers for Disease Control and Prevention, 1600 Clifton Road, Mailstop E-02, Atlanta, GA 30333.

Dr. Zaidi: Centers for Disease Control and Prevention, 1600 Clifton Road, Mailstop E-63, Atlanta, GA 30333.

Dr. Hook: University of Alabama, Birmingham, Division of Infectious Diseases, Tinsley Harrison Tower, Room 215C, 1900 University Boulevard, Birmingham, AL 35294-0006.

Drs. Holmes and Soge: University of Washington, Harborview Medical Center, Department of Global Health and Center for AIDS and STD, 325 9th Avenue, Box 359931, Seattle, WA 98104.

Dr. del Rio: Emory University School of Medicine, Division of Infectious Diseases, 1518 Clifton Road Northeast, Claudia Nance Rollins Building Room 7011, Atlanta, GA 30322.

Dr. Hall: Cleveland Clinic Foundation, Section of Microbiology, 9500 Euclid Avenue, L-40, Cleveland, OH 44195.

Dr. Papp: Centers for Disease Control and Prevention, 1600 Clifton Road, Mailstop A-12, Atlanta, GA 30333.

Author Contributions: Conception and design: R.D. Kirkcaldy, E.W. Hook III, J. Papp.

Analysis and interpretation of the data: R.D. Kirkcaldy, A. Zaidi, J. Papp, G. Bolan, H.S. Weinstock.

Drafting of the article: R.D. Kirkcaldy, A. Zaidi, J. Papp.

Critical revision of the article for important intellectual content: R.D. Kirkcaldy, E.W. Hook III, C. del Rio, G. Hall, J. Papp, H.S. Weinstock.

Final approval of the article: R.D. Kirkcaldy, A. Zaidi, E.W. Hook III, K.H. Holmes, O. Soge, C. del Rio, G. Hall, H.S. Weinstock.

Provision of study materials or patients: E.W. Hook III, G. Hall.

Statistical expertise: A. Zaidi.

Obtaining of funding: K.H. Holmes, C. del Rio.

Administrative, technical, or logistic support: R.D. Kirkcaldy, O. Soge, G. Hall, G. Bolan, H.S. Weinstock.

Collection and assembly of data: R.D. Kirkcaldy, E.W. Hook III, O. Soge, C. del Rio, G. Hall, J. Papp.


Ann Intern Med. 2013;158(5_Part_1):321-328. doi:10.7326/0003-4819-158-5-201303050-00004
Text Size: A A A

This article has been corrected. The original version (PDF) is appended to this article as a supplement.

Chinese translation

Background: 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).

Objective: 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.

Design: 6 years of surveillance data from the Gonococcal Isolate Surveillance Project.

Setting: Publicly funded sexually transmitted disease clinics in 30 U.S. cities.

Patients: Men with a total of 34 600 episodes of symptomatic urethral gonorrhea.

Measurements: 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.

Results: 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).

Limitations: Sentinel surveillance may not be representative of all patients with gonorrhea. HIV status, travel history, and antimicrobial use data were missing for some patients.

Conclusion: 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.

Primary Funding Source: Centers for Disease Control and Prevention.

Figures

Grahic Jump Location
Figure.

Locations of participating sentinel sites and regional laboratories in the GISP.

Sites had continuous participation between 2005 and 2010 with the following exceptions (and years of participation): Kansas City, Missouri (2007–2010); Long Beach, California (2005–2007); New York, New York (2006–2010); Richmond, Virginia (2007–2010); and Tripler AMC (2006–2010). AMC = Army Medical Center; GISP = Gonococcal Isolate Surveillance Project.

Grahic Jump Location

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