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Current Trends Penicillinase-Producing Neisseria gonorrhoeae -- United States, Florida

During the first 9 months of 1985, CDC received reports of 6,020 cases of penicillinase-producing Neisseria gonorrhoeae (PPNG) among civilians, over twice the 2,973 cases reported for the same period in 1984. For the first time, PPNG has been reported from all 50 states within a given calendar year. Three areas, New York City, Los Angeles, and Florida, accounted for 71% of all cases, and all three experienced large increases in 1985 (Figure 2).

In New York City, reported PPNG has increased from 311 cases during the first 9 months of 1984 to 1,015 cases during the same period in 1985 (226%). In Los Angeles, PPNG increased from 179 cases in 1984 to 389 cases in 1985 (117%).

In Florida, PPNG increased from 1,109 cases in 1984 to 2,898 cases in 1985 (161%). PPNG accounted for 7% of all reported gonorrhea morbidity in Florida and is concentrated in the southernmost portion of the state. The number of cases has progressively increased since 1981, despite a temporary plateau during 1983-1984. The five counties reporting the most cases were: Dade (1,740), Palm Beach (266), Broward (220), Orange (143), and Hillsborough (124) (Figure 3). PPNG has spread slowly northernward during 1985, with 36 of 67 Florida counties reporting PPNG cases.

PPNG, as a percentage of all reported gonorrhea, was highest in Dade County, a metropolitan area of 1.8 million people that includes the city of Miami. During the first 9 months of 1985, 35% of all reported gonorrhea in Dade County was attributable to PPNG. This proportion increased from 25% of cases in January to over 51% in September.

PPNG patients were predominantly male (67%) and black (86%). However, these proportions are not appreciably different from patients with penicillin-sensitive N. gonorrhoeae and may represent the patient population seen in public health clinics. Less than 10% of total gonorrhea morbidity (including PPNG) in Dade County is reported by private physicians and hospital emergency rooms. Interviews with infected patients have suggested that nonprescription use of antibiotics and drug-related, part-time prostitution have contributed to this epidemic. Case-control studies to determine the influence of these factors are being implemented. Reported by R Morgan, MD, Dade County Dept of Public Health, Preventive Health Svcs, JJ Witte, MD, State Epidemiologist, Florida Dept of Health and Rehabilitative Svcs; Epidemiology Research Br, Program Svcs Br, Div of Sexually Transmitted Diseases, Center for Prevention Svcs, CDC.

Editorial Note

Editorial Note: Since the introduction of PPNG into the United States in 1976, outbreaks have been reported from several areas, including New York City (1), Los Angeles (2), Shreveport, Louisiana (3), and Washington state (4). The epidemic situation in south Florida, however, is without precedent in the United States. Although PPNG rates comparable to those reported here have been observed in Southeast Asia (5), this is the first time that absolute and proportional rates of this magnitude have been seen in the United States.

The number of PPNG cases reported in Florida may substantially underestimate the disease. The low number of reported gonorrhea cases from the private health sector is probably due to underreporting. Moreover, transmission of disease by prostitutes and the inappropriate use of antibiotics have been cited as contributing factors to the south Florida epidemic, as well as in some nations of Southeast Asia (6).

In response to this outbreak, the Florida Sexually Transmitted Diseases Control Program plans to revise certain aspects of clinical and laboratory services and disease intervention (contact-tracing) procedures. Educational programs for both health professionals and the general public will be initiated. On a national level, CDC reemphasizes the necessity of testing all gonococcal isolates for B-lactamase production (7) and suggests that all patients with a presumptive diagnosis of gonorrhea, who have recently traveled to Florida, Los Angeles, New York City, or Southeast Asia, be treated for PPNG according to treatment schedules published in the 1985 STD Treatment Guidelines (8). Copies of these guidelines can be obtained by writing to Technical Information Services, Center for Prevention Services, CDC, Atlanta, Georgia 30333.

References

  1. CDC. Penicillinase-producing Neisseria gonorrhoeae (PPNG) number of reported cases United States: calendar years 1976-1983. Sexually Transmitted Disease Statistics, 1983. Atlanta, Georgia: U.S. Department of Health and Human Services, Public Health Service, 1985;133:5.

  2. CDC. Penicillinase-producing Neisseria gonorrhoeae--Los Angeles. MMWR 1983;32:181-3.

  3. CDC. An outbreak of penicillinase-producing Neisseria gonorrhoeae--Shreveport, Louisiana. MMWR 1980;29:241-3.

  4. Handsfield HH, Sandstrom EG, Knapp JS, et al. Epidemiology of penicillinase-producing Neisseria gonorrhoeae infections: analysis by auxotyping and serogrouping. N Engl J Med 1982;306:950-4.

  5. Brown S, Warnnissorn T, Biddle J, Panikabutra K, Traisupa A. Antimicrobial resistance of Neisseria gonorrhoeae in Bangkok: is single-drug therapy passe? Lancet 1982;ii:1366-8.

  6. CDC. Penicillinase-producing Neisseria gonorrhoeae--United States, worldwide. MMWR 1979;28:85-7.

  7. CDC. Infections due to penicillinase-producing Neisseria gonorrhoeae--Florida. MMWR 1981;30:245-7.

  8. CDC. STD treatment guidelines. MMWR 1985;34(suppl 4):75S-109S.



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