Neisseria gonorrhoeae in a London sexually transmitted infection clinic not fully sensitive to quinolones: are isolates imported and how effective isciprofloxaclin as a first-line therapy?

Our objectives were to determine the prevalence of Neisseria gonorrhoeae no t fully sensitive to ciprofloxacin from a sexually transmitted infection (S TI) clinic in London and where the isolates were acquired from. Data of ant ibiotic sensitivities of N. gonorrhoeae from 292 patients were reviewed ove r a B-month period at St Mary's Genitourinary Medicine (GUM) Clinic, London . Isolates which exhibited reduced susceptibility (minimum inhibitory conce ntration [MIC] 0.03-0.12mg/l) and high level resistance (MIC>0.12mg/l) to c iprofloxacin represented 10% and 1.3% of the total respectively. All patien ts infected with a high level resistant isolate to ciprofloxacin had had a recent sexual partner from abroad but 18 of the 28 patients infected with a reduced susceptibility isolate denied recent travel. None of the 20 patien ts with a non-sensitive isolate who re-attended for post treatment cultures had persistant gonococcal infection. From this study we concluded that alt hough N. gonorrhoeae resistant to ciprofIoxacin was rare and probably alway s acquired abroad, isolates exhibiting reduced susceptibility were more com mon and were mainly as a result of infection from the UK. A stat close of c iprofloxacin 500 mg and doxycycline 100 mg twice a day for one week was eff ective treatment.