Factors related to increasing prevalence of resistance to ciprofloxacin and other antimicrobial drugs in Neisseria gonorrhoeae, United States

Abstract

Using data from the Gonococcal Isolate Surveillance Project, we studied changes in ciprofloxacin resistance in Neisseria gonorrhoeae isolates in the United States during 2002-2007. Compared with prevalence in heterosexual men, prevalence of ciprofloxacin-resistant N. gonorrhoeae infections showed a more pronounced increase in men who have sex with men (MSM), particularly through an increase in prevalence of strains also resistant to tetracycline and penicillin. Moreover, that multidrug resistance profile among MSM was negatively associated with recent travel. Across the surveillance project sites, first appearance of ciprofloxacin resistance in heterosexual men was positively correlated with such resistance for MSM. The increase in prevalence of ciprofloxacin resistance may have been facilitated by use of fluoroquinolones for treating gonorrhea and other conditions. The prominence of multidrug resistance suggests that using other classes of antimicrobial drugs for purposes other than treating gonorrhea helped increase the prevalence of ciprofloxacin-resistant strains that are also resistant to those drugs.

Figure 1

Semiannual prevalence of resistance to ciprofloxacin in Neissseria gonorrhoeae isolates from the Gonococcal Isolate Surveillance Program for men who have sex with men (MSM), heterosexual men, and bisexual men.

Figure 2

Semiannual prevalence of the ciprofloxacin (Cipro)–resistant type of Neisseria gonorrhoeae for men who have sex with men (A) and heterosexual men (B), stratified by resistance characteristics to tetracycline (tet) and penicillin (pen).

Figure 3

Semiannual prevalence of recent travel history in different type carriers for men who have sex with men (A) and heterosexual men (B). Ciprofloxacin (Cipro) sensitive, MIC <0.0625 μm/L.

Figure 4

First month of appearance of ciprofloxacin resistance in Neisseria gonorrhoeae isolates from heterosexual men and from men who have sex with men (MSM). ALB, Albuquerque, NM; ATL, Atlanta, GA; BAL, Baltimore, MD; BHM, Birmingham, AL; CHI, Chicago, IL; CLE, Cleveland, OH; LBC, Long Beach, CA; MIA, Miami, FL; MIN, Minneapolis, MN; PHI, Philadelphia, PA; PHX, Phoenix, AZ; POR, Portland, OR.