Abstract

PIP: Strains of penicillinase-producing Neisseria gonorrhoeae (PPNG) continue to spread throughout the world. Many countries with good surveillance systems have observed a 2-6 fold increase in the number of such cases reported within the last 18-24 months (through May 1981). Many areas of the world currently have a high proportion of patients for whom penicillin therapy is ineffective because of gonococcal strains with plasmid-mediated resistance. It may be difficult to identify alternative regimens for effective treatment, and alternative regimens may result in increased treatment costs to the point where many governments or patients can no longer afford such treatment. Consequently, less effective treatments continue to be used. This further selects for drug resistance and extends the infectious period for patients. Gonorrhea transmission may be expected to continue, and the proportion of infected patients who develop complications may be expected to rise. The number of cases of PPNG infection reported in the US increased from 328 in 1979 to 1099 in 1980 and to 1910 in the 1st 9 months of 1981. This trend apparently resulted from increases in numbers of cases of imported disease (maninly from the Philippines, Thailand, and the Republic of Korea) and from sustained domestic transmission in major metropolitan areas. The effect of such continuing importation can be minimized by more widespread adherence to the use of 2 gm of spectinomycin for initial treatment of uncomplicated, anogenital gonorrhea in patients who acquired the disease in countries with areas of high PPNG prevalence. In some areas of the US, intensified efforts have been successful in controlling the infection even after a period of sustained domestic transmission. Continued efforts to control PPNG in the US must include testing of all gonococcal isolates for penicillinase production, prompt identification of sexual partners of all PPNG patients, screening of all groups considered to be at high risk of PPNG infection; and treatment of all of the following with 2 gm of spectinomycin: all PPNG patients and their sexual partners; patients who acquired gonorrhea in countries with high PPNG prevalence; and all patients for whom penicillin, ampicillin, amoxicillin, or tetracycline are ineffective treatment for gonorrhea. Evaluation of control strategies in the US will continue. Operational research is essential in countries with high PPNG prevalence.