Cases of resistant N. gonorrhoeae seen in San Diego
Neisseria gonorrhoeae cases resistant to azithromycin detected in San Diego led the Centers for Disease Control and Prevention to issue a â€Dear Colleague†letter reminding clinicians to limit use of azithromycin monotherapy to treat uncomplicated rectal and genitourinary infections caused by N. gonorrhoeae.
Such monotherapy typically is used in patients allergic to cephlosporins because recommended treatment for uncomplicated rectal and genitourinary N. gonorrhoeae infection is dual therapy including a 1-g dose of azithromycin and a cephalosporin.
The resistance concerns are related to five N. gonorrhoeae cases with reduced susceptibility to azithromycin, the CDC reported.
“The five N. gonorrhoeae infections with high MICs to azithromycin identified in MSM [men who have sex with men] during a three-month period in 2010 in San Diego County amount to an unusually large cluster,†according to the report. The infections were identified in MSM with no known connections to each other — prompting concerns that the gonorrhea strains with reduced drug susceptibility might be more widespread in the community. The men presented with symptomatic urethritis.
The five cases were identified between August and October 2009 at San Diego County’s main municipal sexually transmitted diseases clinic. The five isolates had high azithromycin minimum inhibitory concentrations (MICs): three with 8 mcg/mL and two with 16 mcg/mL. The five were among 55 (9%) N. gonorrhoeae isolates obtained from men with symptomatic urethritis tested during the three-month period.
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