Skip to main content

The Management of Antibiotic-Resistant Neisseria gonorrhoeae

  • Chapter
Management of Multiple Drug-Resistant Infections

Part of the book series: Infectious Disease ((ID))

  • 135 Accesses

Abstract

Gonorrhea is a common cause of bacterial sexually transmitted infection (STI), and in many countries (such as the United Kingdom), it is second only to chlamydial infection (1). In many industrialized countries, the epidemiology of gonorrhea has changed in the last 15–20 yr. After the advent of acquired immunodeficiency syndrome (AIDS) in 1984, there was a rapid decline in the number of cases of STIs, including gonorrhea, reaching a trough in 1990–1991. This decline was followed initially by small increases in the number of cases, which has been sustained with significant increases in STIs in the last 5 yr (1).

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 89.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. PHLS, DHSS and PS and the Scottish ISD(D)5 Collaborative Group. Sexually Transmitted Infections in the UK: New Episodes Seen at Genitourinary Medicine Clinics, 1991-2001. London: Public Health Laboratory Service, 2002.

    Google Scholar 

  2. Fitzgerald M, Bedford C. National standards for the management of gonorrhoea. Int J STD AIDS 1996; 7: 298 - 300.

    Article  PubMed  CAS  Google Scholar 

  3. Handsfield HH, McCutchan JA, Corey L, Ronald AR. Evaluation of new anti-infective drugs for the treatment of uncomplicated gonorrhea in adults and adolescents. Infectious Diseases Society of America and the Food and Drug Administration. Clin Infect Dis 1992; 15 (suppl. 1): S123 - S130.

    Article  PubMed  Google Scholar 

  4. Centers for Disease Control. CDC Sexually Transmitted Diseases Guidelines 2002Gonococcal Infections. 2002. Available at: http://www.cdc.gov/std/treatment/42002TG.htm#Gonococcal. Accessed September 9, 2003.

    Google Scholar 

  5. World Health Organization. WHO Guidelines for the Management of Gonococcal Infections. 2001. Available at: http://www.who.int/STIManagemntguidelines/who_hiv_aids_ 2001.01/003.htm#3.1. Accessed September 9, 2003.

    Google Scholar 

  6. Bignell C. 2001 National Guideline for the Management of Gonorrhoea in Adults. Clinical Effectiveness Group of MSSVD/AGUM. 2001. Available at: http://www.mssvd.org.uk/ PDF/CEG2001/gc%200601.PDF. Accessed September 9, 2003.

    Google Scholar 

  7. Goodfellow A, Standley T, Ross JD. Predicting penicillin resistance in patients with gonorrhoea. Sex Transm Infect 1999; 75: 190.

    Article  PubMed  CAS  Google Scholar 

  8. Morse SA, Lysko PG, McFarland L, et al. Gonococcal strains from homosexual men have outer membranes with reduced permeability to hydrophobic molecules. Infect Immun 1982; 37: 432 - 438.

    PubMed  CAS  Google Scholar 

  9. Tapsall J. Antimicrobial Resistance to Neisseria gonorrhoeae. Geneva, Switzerland: World Health Organization, 2001. WHO/CDS/CSR/DRS/2001.3.

    Google Scholar 

  10. Kraus SJ. Incidence and therapy of gonococcal pharyngitis. Sex Transm Dis 1979; 6: 143 - 147.

    Article  PubMed  CAS  Google Scholar 

  11. Ropp PA, Hu M, Olesky M, Nicholas RA. Mutations in ponA, the gene encoding penicillin-binding protein 1, and a novel locus, penC, are required for high-level chromosomally mediated penicillin resistance. Antimicrob Agents Chemother 2002; 46: 769 - 777.

    Article  PubMed  CAS  Google Scholar 

  12. Faruki H, Kohmescher RN, McKinney WP, Sparling PF. A community-based outbreak of infection with penicillin-resistant Neisseria gonorrhoeae not producing penicillinase (chromosomally mediated resistance). N Engl J Med 1985; 313: 607 - 611.

    Article  PubMed  CAS  Google Scholar 

  13. Ashford WA, Golash RG, Hemming VG. Penicillinase-producing Neisseria gonorrhoeae. Lancet 1976; 2: 657 - 658.

    Article  PubMed  CAS  Google Scholar 

  14. Percival A, Rowlands J, Corkhill JE, et al. Penicillinase-producing gonococci in Liverpool. Lancet 1976; 2: 1379 - 1382.

    Article  PubMed  CAS  Google Scholar 

  15. Spratt BG. Hybrid penicillin-binding proteins in penicillin-resistant strains of Neisseria gonorrhoeae. Nature 1988; 332: 173 - 176.

    Article  PubMed  CAS  Google Scholar 

  16. Brannigan, JA, Tirodimos IA, Zhang QY, Dowson CG, Spratt BG. Insertion of an extra aminoacid is the main cause of the low affinity of penicillin-binding protein 2 in penicillin resistant strains of Neisseria gonorrhoeae. Mol Microbiol 1990; 4: 913 - 919.

    Article  PubMed  CAS  Google Scholar 

  17. Hagman KE, Pan W, Spratt BG, Balthazar JT, Judd RC, Shafer WM. Resistance of Neisseria gonorrhoeae to antimicrobial hydrophobic agents is modulated by the mtrRCDE efflux system. Microbiology 1995; 141: 611 - 622.

    Article  PubMed  CAS  Google Scholar 

  18. Delahay RM, Robertson BD, Balthazar JT, Shafer WM, Ison CA. Involvement of the gonococcal MtrE protein in the resistance of Neisseria gonorrhoeae to toxic hydrophobic agents. Microbiology 1997; 143: 2127 - 2133.

    Article  PubMed  CAS  Google Scholar 

  19. Sparling PF, Sarubbi FA Jr, Blackman E. Inheritance of low-level resistance to penicillin, tetracycline and chloramphenicol in Neisseria gonorrhoeae. J Bacteriol 1975; 124: 740 - 749.

    PubMed  CAS  Google Scholar 

  20. Gill MJ, Simjee S, Al-Hattawi K, Robertson BD, Easmon CSF, Ison CA. Gonococcal resistance to 13-lactams and tetracycline involves mutation in loop 3 of the porin encoded at the penB locus. Antimicrob Agents Chemother 1998; 42: 2799 - 2803.

    PubMed  CAS  Google Scholar 

  21. Ropp PA, Nicholas RA. Cloning and characterization of the ponA gene encoding penicillin-binding protein 1 from Neisseria gonorrhoeae and Neisseria meningitidis. J Bacteriol 1997; 179: 2783 - 2787.

    PubMed  CAS  Google Scholar 

  22. Roberts M, Elwell LP, Falkow S. Molecular characterization of two (3-lactamase-specifying plasmids isolated from Neisseria gonorrhoeae. J Bacteriol 1977; 131: 557 - 563.

    PubMed  CAS  Google Scholar 

  23. Roberts MC. Plasmids of Neisseria gonorrhoeae and other Neisseria species. Clin Microbiol Rev 1989; 2 (suppl.): S18 - S23.

    PubMed  Google Scholar 

  24. Pagotto F, Aman AT, Ng LK, Teung KH, Brett M, Dillon JA. Sequence analysis of the family of penicillinase-producing plasmids of Neisseria gonorrhoeae. Plasmid 2000; 43: 24 - 34.

    Article  PubMed  CAS  Google Scholar 

  25. WHO Western Pacific Region Gonococcal Antimicrobial Surveillance Programme. Surveillance of antibiotic resistance in Neisseria gonorrhoeae in the WHO Pacific Region, 2000. Commun Dis Intell 2001; 25: 274 - 277.

    Google Scholar 

  26. Bignell CJ. European guideline for the management of gonorrhoea. Int J STD AIDS 2001; 12 (suppl. 3): 27 - 29.

    Article  PubMed  Google Scholar 

  27. Schwebke JR, Whittington W, Rice RJ, Handsfield HH, Hale J, Holmes KK. Trends in susceptibility of Neisseria gonorrhoeae to ceftriaxone from 1985 through 1991. Antimicrob Agents Chemother 1995; 39: 917 - 920.

    Article  PubMed  CAS  Google Scholar 

  28. Ison CA, Bindayna KM, Woodford N, Gill MJ, Easmon CSF. Penicillin and cephalosporin resistance in gonococci. Genitourin Med 1990; 66: 351 - 356.

    PubMed  CAS  Google Scholar 

  29. Galimand M, Gerbaud G, Courvalin P. Spectinomycin resistance in Neisseria spp due to mutations in 16S rRNA. Antimicrob Agents Chemother 2000; 44: 1365 - 1366.

    Article  PubMed  CAS  Google Scholar 

  30. Boslego JW, Tramont EC, Takafuji ET, et al. Effect of spectinomycin use on the prevalence of spectinomycin resistant and of penicillinase-producing Neisseria gonorrhoeae. N Engl J Med 1987; 317: 272 - 278.

    Article  PubMed  CAS  Google Scholar 

  31. Spectinomycin-resistant penicillinase producing Neisseria gonorrhoeae -California. MMWR Morb Mortal Wkly Rep 1981; 30:221-222.

    Google Scholar 

  32. Zenilman JM, Nims LJ, Menegus MA, Nolte F, Knapp JS. Spectinomycin-resistant gonococcal infections in the United States, 1985-86. J Infect Dis 1987; 156: 1002 - 1004.

    Article  PubMed  CAS  Google Scholar 

  33. Easmon CSF, Ison CA, Bellinger CM, Harris JRW. Emergence of resistance after spectinomycin treatment for gonorrhoea due to (3-lactamase-producing strain of Neisseria gonorrhoeae. BMJ 1982; 284: 1604 - 1605.

    Article  PubMed  CAS  Google Scholar 

  34. Drlica K, Zhao X. DNA gyrase, topisomerase IV, and the 4-quinolones. Microbiol Mol Biol Rev 1997; 61: 377 - 392.

    PubMed  CAS  Google Scholar 

  35. Belland RJ, Morrison SG, Ison C, Huang WM. Neisseria gonorrhoeae acquires mutations in analogous regions of gyrA and parC in fluoroquinolone-resistant isolates. Mol Microbiol 1994; 14: 371 - 380.

    Article  PubMed  CAS  Google Scholar 

  36. Trees DL, Sandul AL, Whittington WL, Knapp JS. Identification of novel mutation patterns in the parC gene of ciprofloxacin-resistant isolates of Neisseria gonorrhoeae. Antimicrob Agents Chemother 1998; 42: 2103 - 2105.

    PubMed  CAS  Google Scholar 

  37. Trees DL, Sandul AL, Neal SW, Higa H, Knapp JS. Molecular epidemiology of Neisseria gonorrhoeae exhibiting decreased susceptibility and resistance to ciprofloxacin in Hawaii, 1991-1999. Sex Transm Dis 2001; 28: 309 - 314.

    Article  PubMed  CAS  Google Scholar 

  38. Knapp JS, Fox KK, Trees DL, Whittington WL. Fluoroquinolone resistance in Neisseria gonorrhoeae. Emerg Infect Dis 1997; 3: 33 - 38.

    Article  PubMed  CAS  Google Scholar 

  39. Shultz TR, Tapsall JW, White PA. Correlation of in vitro susceptibilities to newer quinolones of naturally-occurring quinolone-resistant Neisseria gonorrhoeae strains with changes in GyrA and ParC. Antimicrob Agents Chemother 2001; 45: 734 - 738.

    Article  PubMed  CAS  Google Scholar 

  40. Martinez-Martinez L, Pascual A, Jacoby GA. Quinolone resistance from a transferable plasmid. Lancet 1998; 351: 797 - 799.

    Article  PubMed  CAS  Google Scholar 

  41. Young H, Moyes A, McMillan A. Azithromycin and erythromycin resistant Neisseria gonorrhoeae following treatment with azithromycin. Int J STD AIDS 1997; 8: 299 - 302.

    Article  PubMed  CAS  Google Scholar 

  42. Zaratonnelli L, Borthagaray G, Lee E-H, Shafer WM. Decreased azithromycin susceptibility of Neisseria gonorrhoeae due to mtrR mutations. Antimicrob Agents Chemother 1999; 43: 2468 - 2472.

    Google Scholar 

  43. Xia M, Whittington WL, Shafer WM, Holmes KK. Gonorrhoea among men who have sex with men: an outbreak caused by a single genotype of erythromycin-resistant Neisseria gonorrhoeae with a single-base pair deletion in the mtrR promotor region. J Infect Dis 2000; 181: 2080 - 2082.

    Article  PubMed  CAS  Google Scholar 

  44. Shafer WM, Veal WL, Lee EH, Zarantonelli L, Balthazar JT, Roquette C. Genetic organization and regulation of antimicrobial efflux system possessed by Neisseria gonorrhoeae and Neisseria meningitidis. J Mol Microbiol Biotechnol 2001; 3: 219 - 224.

    PubMed  CAS  Google Scholar 

  45. Luna VA, Cousin S Jr, Whittington WL, Roberts MC. Identification of the conjugative mef genes in clinical Acinetobacter junii and Neisseria gonorrhoeae isolates. Antimicrob Agents Chemother 2000; 44: 2503 - 2506.

    Article  PubMed  CAS  Google Scholar 

  46. Roberts MC, Chung WO, Roe D, et al. Erythromycin-resistant Neisseria gonorrhoeae and oral commensal Neisseria spp. carry known rRNA methylase genes. Antimicrob Agents Chemother 1999; 43: 1367 - 1372.

    PubMed  CAS  Google Scholar 

  47. Ng L-K, Martin I, Liu G, Bryden L. Mutation in 23S rRNA associated with macrolide resistance in Neisseria gonorrhoeae. Antimicrob Agents Chemother 2002; 46: 3020 - 3025.

    Article  PubMed  CAS  Google Scholar 

  48. Johnson SR, Morse SA. Antibiotic resistance in Neisseria gonorrhoeae, genetics and mechanisms of resistance. Sex Transm Dis 1988; 15: 217 - 224.

    Article  PubMed  CAS  Google Scholar 

  49. Morse SA, Johnson SR, Biddle JW, Roberts MC. High-level tetracycline resistance in Neisseria gonorrhoeae is result of acquisition of streptococcal tetM determinant. Antimicrob Agents Chemother 1986; 30: 664 - 670.

    Article  PubMed  CAS  Google Scholar 

  50. Knapp JS, Johnson SR, Zenilman JM, Roberts MC, Morse SA. High-level tetracycline resistance resulting from TetM in strains of Neisseria spp, Kingella denitrificans, and Eikenella corrodens. Antimicrob Agents Chemother 1988; 32: 765 - 767.

    Article  PubMed  CAS  Google Scholar 

  51. Daly CC, Hoffman I, Hobbs M, et al. Development of an antimicrobial susceptibility surveillance system for Neisseria gonorrhoeae in Malawi. J Clin Microbiol 1997; 35: 2985 - 2988.

    PubMed  CAS  Google Scholar 

  52. Lkhamsuren E, Shultz TR, Limnios EA, Tapsall JW. The antibiotic susceptibility of Neisseria gonorrhoeae isolated in Ulaanbaatar, Mongolia. Sex Transm Infect 2001; 77: 218 - 219.

    Article  PubMed  CAS  Google Scholar 

  53. West B, Changalucha J, Grooskurth H, et al. Antimicrobial susceptibility, auxotype and plasmid content of Neisseria gonorrhoeae in northern Tanzania: emergence of high-level plasmid mediated tetracycline resistance. Genitourin Med 1995; 71: 9 - 12.

    PubMed  CAS  Google Scholar 

  54. OCallaghan CH, Morris A, Kirby SM, Shingler AH. Novel method for detection of ßlactamases by using chromogenic cephalosporin substrate. Antimicrob Agents Chemother 1972; 1: 283 - 288.

    Article  CAS  Google Scholar 

  55. Livermore DM, Brown DFJ. Detection of ß-lactamase-mediated resistance. J Antimicrob Chemother 2001; 48 (suppl. S1): 59 - 64.

    Article  PubMed  CAS  Google Scholar 

  56. World Health Organization. Bench-Level Manual for Sexually Transmitted Diseases. Geneva, Switzerland: World Health Organization. WHO/VDT/89. 1989, p. 443.

    Google Scholar 

  57. National Committee for Clinical Laboratory Standards. Approved Standard: Performance Standards for Antimicrobial Disk Susceptibility Tests. 5th ed. Villanova, PA: National Committee for Clinical Laboratory Standards. 2003 Document M2-A8.

    Google Scholar 

  58. King A. Recommendations for susceptibility tests on fastidious organisms and those requiring special handling. J Antimicrob Chemother 2001; 48 (suppl.): 77 - 80.

    Article  PubMed  CAS  Google Scholar 

  59. Ison CA, Martin DM. Gonorrhoea. In: Morse SA, Ballard R (eds.). Atlas of Sexually Transmitted Diseases. London: Harcourt Health Sciences, 2002, pp. 109 - 125.

    Google Scholar 

  60. Ison CA, Branley NS, Kirtland K, Easmon CSF. Surveillance of antibiotic resistance in clinical isolates of Neisseria gonorrhoeae. BMJ 1991; 303: 1307.

    Article  PubMed  CAS  Google Scholar 

  61. Members of the Australian Gonococcal Surveillance Programme. Penicillin sensitivity of gonococci in Australia: development of Australian gonococcal surveillance programme. Br J Vener Dis 1984; 60: 226 - 230.

    Google Scholar 

  62. Ison CA, Martin IMC, London Gonococcal Working Group. Susceptibility of gonococci isolated in London to therapeutic antibiotics: establishment of a London surveillance programme. Sex Transm Infect 1999; 75: 107 - 111.

    Article  PubMed  Google Scholar 

  63. Palmer HM, Leeming JP, Turner A. A multiplex polymerase chain reaction to differentiate 13-lactamase plasmids of Neisseria gonorrhoeae. J Antimicrob Chemother 2000; 45: 777 - 782.

    Article  PubMed  CAS  Google Scholar 

  64. Xia M, Pang Y, Roberts MC. Detection of two groups of 25.2 MDa Tet M plasmids by polymerase chain reaction of the downstream region. Mol Cell Probes 1995; 9: 327 - 332.

    Article  PubMed  CAS  Google Scholar 

  65. Ison CA, Tekki N, Gill MJ. Detection of the tetM determinant in Neisseria gonorrhoeae. Sex Transm Dis 1993; 20: 329 - 333.

    Article  PubMed  CAS  Google Scholar 

  66. Deguchi T, Yasuda M, Nakano M, et al. Rapid screening of point mutations of the Neisseria gonorrhoeae gyrA gene associated with decreased susceptibilities to quinolones. J Clin Microbiol 1996; 34: 2255 - 2258.

    PubMed  CAS  Google Scholar 

  67. Deguchi T, Yasuda M, Nakano M, et al. Rapid screening of point mutations of Neisseria gonorrhoeae parC associated with resistance to the quinolones. J Clin Microbiol 1997; 35: 948 - 950.

    PubMed  CAS  Google Scholar 

  68. Ng L-K, Sawatzky P, Martin IE, Booth S. Characterisation of ciprofloxacin resistance in Neisseria gonorrhoeae isolates in Canada. Sex Transm Dis 2002; 29: 780 - 788.

    Article  PubMed  CAS  Google Scholar 

  69. Rahman M, Alam A, Nessa K, et al. Treatment failure with the use of ciprofloxacin for gonorrhea correlates with the prevalence of fluoroquinolone-resistant Neisseria gonorrhoeae strains in Bangladesh. Clin Infect Dis 2001; 32: 884 - 889.

    Article  PubMed  CAS  Google Scholar 

  70. Ng PP, Chan RK, Ling AE. Gonorrhoea treatment failure and ciprofloxacin resistance. Int J STD AIDS 1998; 9: 323 - 325.

    Article  PubMed  CAS  Google Scholar 

  71. OMahony C, Timmins D. Treatment failure using double dose ciprofloxacin in a case of highly resistant gonorrhoea. Genitourin Med 1992; 68: 274 - 275.

    CAS  Google Scholar 

  72. Ison CA, Dillon JR, Tapsall J. The epidemiology of global antibiotic resistance among Neisseria gonorrhoeae and Haemophilus ducreyi. Lancet 1998; 351 (suppl.): 8 - 11.

    Article  PubMed  Google Scholar 

  73. Schwarcz SK, Zenilman JM, Schnell D, et al. National surveillance of antimicrobial resistance in Neisseria gonorrhoeae. JAMA 1990; 264: 1413 - 1417.

    Article  PubMed  CAS  Google Scholar 

  74. Dillon JR. National microbiological surveillance of the susceptibility of gonococcal isolates to antimicrobial agents. Can J Infect Dis 1992; 3: 202 - 206.

    PubMed  CAS  Google Scholar 

  75. Australian Gonococcal Surveillance Program. Penicillin sensitivity of gonococci in Australia: development of Australian gonococcal surveillance program. Genitourin Med 1988; 61: 147 - 151.

    Google Scholar 

  76. Van de Laar MJW, van Duynhoven YTPH, Dessens M, van Santen M, van Klingeren B. Surveillance of antibiotic resistance in Neisseria gonorrhoeae in the Netherlands, 199795. Genitourin Med 1997; 73: 510 - 517.

    PubMed  Google Scholar 

  77. World Health Organization. Global Surveillance Network for Gonococcal Antimicrobial Susceptibility. Geneva, Switzerland: World Health Organization. WHO/VDT/90-452.

    Google Scholar 

  78. Mayaud P, West B, Lloyd-Evans N, Seck K. GASP-WAR: West African network to tackle gonorrhoea. Lancet 2002; 359: 173.

    Article  PubMed  Google Scholar 

  79. GRASP Steering Group. The Gonococcal Resistance to Antimicrobials Surveillance Programme (GRASP) Year 2000 Report. London: Public Health Laboratory Service, 2001.

    Google Scholar 

  80. GRASP Steering Group. The Gonococcal Resistance to Antimicrobials Surveillance Programme (GRASP) Year 2001 Report. London: Public Health Laboratory Service, 2002.

    Google Scholar 

Download references

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2004 Springer Science+Business Media New York

About this chapter

Cite this chapter

Ison, C.A., Ross, J. (2004). The Management of Antibiotic-Resistant Neisseria gonorrhoeae . In: Gillespie, S.H. (eds) Management of Multiple Drug-Resistant Infections. Infectious Disease. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-59259-738-3_9

Download citation

  • DOI: https://doi.org/10.1007/978-1-59259-738-3_9

  • Publisher Name: Humana Press, Totowa, NJ

  • Print ISBN: 978-1-61737-438-8

  • Online ISBN: 978-1-59259-738-3

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics