THE EPIDEMIOLOGY OF NEISSERIA-GONORRHOEAE ISOLATES IN GREENLAND 1979-1990 - THE EMERGENCE, SPREAD AND DISAPPEARANCE OF NON-PPNG STRAINS CARRYING THE CONJUGATIVE 38.9 KB PLASMID

Background: In 1990, Greenland was one of the few areas in the world i n which endemic occurrence of PPNG had not been reported. However, bet ween 1982 and 1988 an increase in the prevalence of strains with chrom osomally mediated resistance to penicillin had been noticed. The stand ard treatment regimen was changed early in 1983. Objective: To determi ne the prevalence of the 38.9 kb plasmid in gonococcal strains isolate d in Greenland 1979-1990. Design: Retrospective (1979-1984) and prospe ctive (1985-1990) studies of antimicrobial susceptibility and plasmid profile of consecutive N. gonorrhoeae isolates from patients attending the STD clinic in Nuuk, Greenland; selected strains from 1982-1984 we re subjected to serotyping and auxotyping. Results: Before 1982, N. go norrhoeae strains harboring the 38.9 kb conjugative plasmid were rare; in 1982, a sudden increase in the prevalence of these strains was str ongly associated with the emergence of streptomycin-resistant strains with high-level chromosomally mediated resistance to penicillin, 70% o f which carried the 38.9 kb plasmid. Determination of antimicrobial su sceptibility pattern, auxotype and serovar supported the assumption of an epidemic spread of a single clone. The predominance of this clone was transient, but the 38.9 kb plasmid spread to penicillin-susceptibl e as well as to other clones of penicillin-resistant strains. Conclusi on: The emergence of the 38.9 kb plasmid in 1982 was linked to a singl e clone of strains, but the subsequent spread of the plasmid was indep endent of the presence of other plasmids, and its disappearance was no t associated with a change in standard treatment regimen.