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International Notes Spectinomycin-Resistant B-Lactamase-Producing Neisseria gonorrhoeae--England

Spectinomycin-resistant B-lactamase-producing strains of Neisseria gonorrhoeae have been isolated from a female, aged 23 years, and a male, aged 29 years, after treatment failure (ampicillin/probenecid followed by spectinomycin), although original isolates were found to be sensitive by disc tests. Both patients acquired the infection in London but are not known to be connected. The consort of the first case was traced and treated without development of spectinomycin resistance. Plasmid analysis of the strains showed that both carried Asian type plasmids. Reported by Communicable Disease Report (London). 1982;32:31.

Editorial Note

Editorial Note: Spectinomycin has been the recommended therapy for persons who have penicillinase producing N. gonorrhoeae (PPNG) infections and for those who have failed to respond to gonorrhea treatment (1). The first of two cases of spectinomycin-resistant PPNG identified in 1981 was reported to CDC by the United States Air Force in California in April 1981 (2). The Air Force conducted an intensive investigation overseas for additional cases related to this initial case; none was identified. The second case was identified in London in November 1981 (3). The 1981 cases and the two recent cases reported above have not been epidemiologically connected.

Spectinomycin-resistant gonococci are uncommon; the total number of reported cases is now eight, four with PPNG and four with non-PPNG. CDC continues to advise that all gonococcal isolates be tested for penicillinase production and that PPNG isolates be tested for spectinomycin resistance (4). Procedures for a provisional disc-diffusion technique are available (5). All spectinomycin-resistant gonococcal isolates should be forwarded to CDC through state health department laboratories; surveillance is essential to describe the distribution and trends of spectinomycin-resistant PPNG. For such cases, the recommended alternative therapies are: cefoxitin 2g intramuscularly (IM) plus probenecid 1g orally or cefotaxime 1g IM (2).

References

  1. CDC. Sexually transmitted diseases, treatment guidelines 1982. MMWR 1982; 31(supplement 2S):35S-60S.

  2. Ashford WA, Potts, DW, Adams HJ, et al. Spectinomycin-resistant penicillinase-producing Neisseria gonorrhoeae. Lancet 1981;2:1035-7.

  3. Easmon CSF, Ison CA, Bellinger CM, Harris JW. Emergence of resistance after spectinomycin treatment for gonorrhoea due to B-lactamase-producing strain of Neisseria gonorrhoeae. Br Med J 1982;284:1604-5.

  4. CDC. Spectinomycin-resistant penicillinase producing Neisseria gonorrhoeae--California. MMWR 1981;30:221-2.

  5. Biddle JW, Swenson JM, Thornsberry C. Disc agar diffusion antimicrobial susceptibility tests with beta-lactamase producing Neisseria gonorrhoeae. J Antibiot (Tokyo) 1978;31:352-8.

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