0

The full content of Annals is available to subscribers

Subscribe/Learn More  >
Articles |

The Emergence of Neisseria gonorrhoeae with Decreased Susceptibility to Ciprofloxacin in Cleveland, Ohio: Epidemiology and Risk Factors

Steven M. Gordon, MD; Cynthia J. Carlyn, MD; Laura J. Doyle, BS; Cynthia C. Knapp, MS; David L. Longworth, MD; Geraldine S. Hall, PhD; and John A. Washington, MD
[+] Article and Author Information

From the Cleveland Clinic Foundation, Cleveland, Ohio. Acknowledgments: The authors thank Victoria Grosh for secretarial assistance and La Tonya Thompson for assistance with patient records. Requests for Reprints: Steven M. Gordon, MD, Department of Infectious Diseases, Mailstop S-32, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195. Current Author Addresses: Drs. Gordon and Longworth: Department of Infectious Diseases, Mailstop S-32, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195.


Copyright ©2004 by the American College of Physicians


Ann Intern Med. 1996;125(6):465-470. doi:10.7326/0003-4819-125-6-199609150-00006
Text Size: A A A

Background: Until 1992, almost all strains of Neisseria gonorrhoeae that had been tested in the United States were susceptible to fluoroquinolones, including ciprofloxacin. However, among men with urethral gonococcal infections who attended one sexually transmitted disease clinic in Cleveland, Ohio, the prevalence of gonococci with decreased susceptibility to ciprofloxacin increased from 2% in 1991 to 16% in 1994.

Objective: To describe the emergence of and risk factors for gonococcal urethritis caused by gonococci with decreased susceptibility to ciprofloxacin. Resistance to ciprofloxacin was considered to be decreased if the mean inhibitory concentration was at least 0.12 µg/mL and was ≤ 0.25 µg/mL; this definition did not equate with the definition of clinical resistance.

Design: Case-control study.

Setting: An urban sexually transmitted disease clinic.

Participants: 51 case-patients and 106 controls.

Measurements: Pulsed-field gel electrophoresis was used to identify individual genotypes of ciprofloxacin-resistant and ciprofloxacin-susceptible isolates.

Results: 55 of the 746 isolates of N. gonorrhoeae that were tested (7.4%) had decreased susceptibility to ciprofloxacin, and the prevalence of N. gonorrhoeae with decreased susceptibility significantly increased during the study period. Case-patients were significantly less likely to have gram-negative diplococci seen on microscopic examination of urethral discharge (P ≤ 0.01) and were less likely to be treated for gonococcal urethritis than were controls (P ≤ 0.001). Molecular typing suggested the spread of a single genotype of N. gonorrhoeae.

Conclusions: Strains of gonococci with decreased susceptibility to ciprofloxacin appear to have become endemic in Cleveland, Ohio. The clinical significance of these isolates is not clear, but the potential for the emergence of clinically important resistance may preclude the use of fluoroquinolones as an alternative treatment for uncomplicated gonorrhea.

Figures

Grahic Jump Location
Figure 1. *  < 0.001 (chi-square test for trend).
Incidence rates of urethral isolates of Neisseria gonorrhoeae with decreased susceptibility to ciprofloxacin among men treated at one sexually transmitted disease clinic in Cleveland, Ohio, between January 1991 and September 1995.P
Grahic Jump Location

Tables

References

Letters

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Comments

Submit a Comment
Submit a Comment

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.

Toolkit

Buy Now

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Advertisement
Related Articles
Journal Club
Related Point of Care
Topic Collections
PubMed Articles
Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.
(Required)
(Required)