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Determinants of emergence of antibiotic-resistant Neisseria gonorrhoeae
E W Hook1, W E Brady, C A Reichart
1Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD 21205.
Abstract:
Studies were carried out to evaluate the prevalence and risk factors for antibiotic-resistant Neisseria gonorrhoeae infections. Monthly surveillance of gonococcal isolates showed the prevalence of gonococci with high-level, plasmid-mediated tetracycline resistance (TRNG) to be about 15% for three consecutive 6-mo periods. Over the same period, the prevalence of gonococci with chromosomally mediated resistance to penicillin G steadily increased, from 0% to 9% and then to 21%. From April to July 1987, while chromosomally mediated penicillin resistance was rapidly increasing, a more intensive study was conducted. Patients infected with TRNG reported significantly more lifetime sexual partners (P less than .05) but otherwise resembled patients infected with antibiotic-sensitive gonococci. Patients infected with chromosomally mediated penicillin-resistant gonococci differed from other patients. In addition to reporting more lifetime partners (P less than .05), patients with chromosomally mediated penicillin-resistant gonorrhea were more likely to be older (P less than .05) and more often reported past episodes of gonorrhea (P less than .05), greater numbers of recent sexual partners (P less than .05), new sexual partners (P less than .05), prostitute contact (P = .06), and parenteral drug use or sexual partners who were drug users (P = .07). The introduction of antibiotic-resistant N. gonorrhoeae into communities may be attributable to a subset of patients who practice "risky behaviors" and who could be targeted for disease intervention activities.
Insights
Antibiotic resistance in Neisseria gonorrhoeae is increasing, particularly penicillin resistance. Certain high-risk behaviors are linked to infections with resistant strains, suggesting targeted intervention strategies.
Area of Science:
- Microbiology
- Infectious Diseases
- Public Health
Background:
- Antibiotic resistance in Neisseria gonorrhoeae poses a significant public health threat.
- Monitoring resistance patterns is crucial for effective treatment and control.
Purpose of the Study:
- To evaluate the prevalence of antibiotic-resistant Neisseria gonorrhoeae.
- To identify risk factors associated with resistant gonococcal infections.
Main Methods:
- Monthly surveillance of gonococcal isolates.
- Analysis of patient demographics and sexual behavior.
- Comparison of risk factors between antibiotic-sensitive and resistant strains.
Main Results:
- Plasmid-mediated tetracycline resistance (TRNG) prevalence was stable at ~15%.
- Chromosomal penicillin resistance increased from 0% to 21% over the study period.
- Patients with penicillin-resistant gonorrhea reported more lifetime partners, were older, and had higher rates of recent/new partners and risky behaviors.
Conclusions:
- The rise in penicillin resistance is concerning.
- Specific patient groups engaging in high-risk behaviors are associated with antibiotic-resistant gonorrhea.
- Targeted interventions for these groups may help control the spread of resistant N. gonorrhoeae.