PLASMID-MEDIATED ANTIMICROBIAL RESISTANCE IN NEISSERIA-GONORRHOEAE INKINGSTON, JAMAICA - 1990-1991

Background and Objectives: Gonococcal infections caused by antimicrobi al-resistant strains of Neisseria gonorrhoeae have spread into many ge ographic areas and have increased in prevalence since the mid 1970s, S urveillance of antimicrobial-resistant gonococcal strains in Jamaica f rom 1981 to 1983 indicated that fewer than 3% of strains produced beta -lactamase (penicillinase-producing Neisseria gonorrhoeae ); approxima tely 4% of strains were resistant to penicillin, and 12% were resistan t to tetracycline. Goal of this Study: To measure the frequency and na ture of antimicrobial resistance in Neisseria gonorrhoeae isolates in Kingston, Jamaica, from 1990 to 1991 and to assess the effectiveness o f prescribed treatment regimens. Study Design: Urethral isolates of Ne isseria gonorrhoeae from 116 heterosexual men with uncomplicated gonor rhea, representing 7.1% (116/1633) men attending the STD Comprehensive Health Centre from October 1990 through March 1991 who had positive G ram-stained smears, were characterized by auxotype, serovar, presence of the TetM determinant, and plasmid content, Antimicrobial susceptibi lities to penicillin, cefoxitin, ceftriaxone, ciprofloxacin, tetracycl ine, and spectinomycin were determined by an agar dilution method. Res ults: A total of 80.2% (93/116) of the isolates exhibited plasmid-medi ated resistance to penicillin, tetracycline, or both: penicillinase-pr oducing Neisseria gonorrhoeae (13/116; 11.2%), tetracycline-resistant Neisseria gonorrhoeae (25/116; 21.6%), and penicillinase-producing/tet racycline-resistant Neisseria gonorrhoeae (55/116; 47.4%), Isolates wi th chromosomally mediated resistance to penicillin, tetracycline, or b oth, accounted for 5.2% (6/116) of the isolates, Penicillinase-produci ng Neisseria gonorrhoeae, tetracycline-resistant Neisseria gonorrhoeae hoeae, and penicillinase-producing/tetracycline-resistant Neisseria g onorrhoeae belonging to multiple auxotype/serovar classes were isolate d repeatedly through the study period. Conclusions: Infections caused by Neisseria gonorrhoeae exhibiting plasmid-mediated resistance to pen icillin, tetracycline, or both, have become prevalent and endemic in K ingston, Jamaica, Therefore, all gonococcal infections should he treat ed with antimicrobial therapies known to be active against penicillin- resistant and tetracycline-resistant organisms to reduce gonorrhea tra nsmission.