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Gonorrhoea remains the second most common sexually transmitted infection in the United States, and resistance to fluoroquinolone antibiotics seems to be spreading. An analysis of data from 82064 gonococcal isolates collected by a multisite surveillance programme over the 16 years to 2003 found that 4.1% of Neisseria gonorrhoeae samples collected in 2003 were resistant to fluoroquinolone treatment, up from 0.4% in 1999. The fluoroquinolones include ciprofloxacin, ofloxacin, and levofloxacinlevofloxacin.
The first resistant strains were found in 1991. By 1999, fluoroquinolone resistance was found in 39% of cities surveyed (10/26), and by 2003 resistance had spread to 70% of cities surveyed (21/30). Fluoroquinolones mostly replaced penicillin, and the proportion of patients treated rose from 0% in 1988 to 42% by 2003. Resistance to penicillin peaked in 1991, at 19.6%, but had fallen to 6.5% by 2003. Resistance to ceftriaxone, cefixime, spectinomycin, and azithromycin remains rare.
The authors note that the sentinel surveillance programme—which includes mainly men attending public sexual health clinics—may not accurately reflect the picture in the general US population, or in specific locations. Doctors should also consult local surveillance data to help inform their treatment decisions.