MOLECULAR EPIDEMIOLOGY OF INFECTIONS WITH NEISSERIA-GONORRHOEAE AMONGVISITORS TO A SEXUALLY-TRANSMITTED DISEASES CLINIC

Objectives: To identify determinants for plasmid-mediated resistance t o penicillin (penicillinase-producing Neisseria gonorrhoeae [TRNG]) an d tetracycline (tetracycline-resistant N. gonorrhoeae [TRNG]) among go nococci, to determine the distribution of bacterial characteristics, a nd to correlate these with antibiograms and patient characteristics. S tudy Design: Gonococcal isolates from 131 patients attending a sexuall y transmitted diseases clinic in The Netherlands in 1994 were auxotype d and serotyped and antimicrobial susceptibility was tested, Informati on on patient characteristics was collected at the initial visit. Resu lts: The most prevalent serotype, IB-1 (26%), proved to be related to sexual contact with casual partners, especially commercial sex partner s. In addition, IB-1 strains were associated with PPNG and displayed h igher minimum inhibitory concentrations (MICs) for ceftriaxone, cefuro xime, and ciprofloxacin, Homosexual men were more often infected with nonrequiring, 1B-2, and IB-6 strains than heterosexuals. These strains were very sensitive to ceftriaxone and ciprofloxacin. Overall, one st rain showed decreased susceptibility to ciprofloxacin (MIC 0.5 mu g/ml ), but no resistance to ceftriaxone, ciprofloxacin, or cefuroxime was observed. However, 31% of the isolates were TRNG, PPNG, or both, Deter minants for these resistant strains among men were the use of antibiot ics (odds ratio [OR] = 4.8, 90% confidence interval [CI] 1.3-19.1), Su rinam or Morrocan origin (OR = 3.3, 90% CI 1.3-8.4), and homosexual co ntacts (OR = 0.1, 90% CI 0.03-0.4). Conclusions: Different types, with variable susceptibility, were associated with homosexual and commerci al sexual behavior, PPNG and TRNG were more commonly isolated from ant ibiotic users, heterosexual individuals, and ethnic minorities, Contin uous surveillance of susceptibility is needed to follow the spread of PPNG and TRNG and to detect resistance to the currently recommended ag ents in a timely fashion.