A ONE-YEAR SURVEY OF NEISSERIA-GONORRHOEAE ISOLATED FROM PATIENTS ATTENDING AN EAST LONDON GENITOURINARY MEDICINE CLINIC - ANTIBIOTIC SUSCEPTIBILITY PATTERNS AND PATIENTS CHARACTERISTICS

Objectives-To collect epidemiological data on gonococcal infection in an east London genitourinary medicine (GUM) clinic; to perform antibio tic susceptibility testing on Neisseria gonorrhoeae isolates and relat e results to patient data; to assess the efficacy of current first-lin e antibiotic therapy for treating gonorrhoea. Methods-Gonococcal isola tes were collected from 113 patients attending the GUM clinic at Newha m General Hospital over a one year period. Isolates (104) were tested for susceptibility to various antibiotics. Plasmid profiles were obtai ned for penicillinase producing gonococci (PPNG) and isolates exhibiti ng high-level tetracycline resistance (TRNG). Epidemiological informat ion was collected from clinic attenders by routine note-taking. Result s-PPNG (16) accounted for 15% of isolates tested, only three being acq uired outside the United Kingdom (U.K.). Plasmid typing showed three t ypes of P-lactamase-encoding plasmids were represented (2.9 MDa, 3.2 M Da and 4.4 MDa). Amongst the non-PPNG isolates, high-level chromosomal resistance to penicillin (CMRNG) was found in 3.5%, intermediate resi stance in 57.5% and full. susceptibility in 39%. One isolate showed de creased susceptibility to ciprofloxacin (MIC = 0.06 mg/l). Three PPNG isolates also possessed a 25.2 MDa plasmid and expressed high-level te tracycline resistance encoded by tetM. All isolates were susceptible t o cefixime, cefotaxime, azithromycin and spectinomycin. Most gonorrhoe a (90%) was seen in local residents. The male:female case ratio was 2: 1 with homosexually-acquired gonorrhoea accounting for only 3.5% of th e total. Most patients (96%) had acquired gonorrhoea in the U.K.. A pa st history of gonorrhoea was more frequent in male patients. Concurren t chlamydial infection was seen in 31% females and 16% males. Conclusi ons-The high PPNG rate supports a previous decision to change first-li ne therapy from amoxycillin with probenecid to ciprofloxacin. There wa s no evidence of clinical treatment failure with ciprofloxacin. Cefixi me, cefotaxime, azithromycin and spectinomycin all appear to be suitab le alternative therapies. Acquisition of gonorrhoea abroad was associa ted with isolates exhibiting penicillin resistance but such isolates w ere also obtained from patients infected locally and without a history of foreign travel.