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Spectinomycin-Resistant Penicillinase-Producing Neisseria gonorrhoeae

Transmission of spectinomycin-resistant penicillinase-producing Neisseria gonorrhoeae (PPNG) has been documented for the first time. Between August 1982 and January 1983, 27 cases of spectinomycin-resistant PPNG infection were reported by U.S. Air Force Facilities in the Pacific. Twenty-five of these cases occurred among U.S. Air Force personnel stationed at Osan or Kunsan, Republic of Korea. At least eight spectinomycin-resistant PPNG isolates were identified in pretreatment cultures obtained from individuals with recently acquired gonococcal urethritis.

Strains collected from six of the patients have already been confirmed by CDC as spectinomycin-resistant and penicillinase-producing. Additional analyses show that all these strains contain plasmids of 2.6, 4.4, and 24.5 megadaltons, are serogroup W-II, and require proline for growth. Reported by O Jones, MD, USAF Hospital, Osan, G Strohmeyer, MD, USAF Hospital, Kunsan, Korea; J Brockett, PhD, USAF Regional Medical Center, Clark Air Force Base; J Wright, MD, HQ, US PACAF; P Grundy, MD, G Lathrop, MD, W Wolfe, MD, J Herbole, DVM, Epidemiology Div, USAF School of Aerospace Medicine; Sexually Transmitted Diseases Research Laboratory, Center for Infectious Diseases, Div of Venereal Disease Control, Center for Prevention Svcs, CDC.

Editorial Note

Editorial Note: Until now, person-to-person transmission of spectinomycin-resistant PPNG organisms had not been described. Previously reported cases of spectinomycin-resistant PPNG infection have been sproadic and have occurred among individuals without known contact (1-4). Factors contributing to the emergence and sustained transmission of these organisms are currently unknown.

Importation of spectinomycin-susceptible PPNG from Korea continued in 1982, and included at least 53 cases reported by 16 different states during the first 9 months (5). No spectinomycin-resistant PPNG originating from Korea has been identified in the United States, but continued transmission of this doubly resistant organism within Korea and continued importation of gonococci from that country make eventual importation probable.

In 1982, the U.S. Air Force (Pacific) began testing all gonococcal isolates for penicillinase production. All PPNG isolates and all isolates from patients who failed spectinomycin therapy were tested for spectinomycin-resistance. Because of the implementation of this surveillance system, the occurrence and distribution of this outbreak can be readily described.

Despite this outbreak, spectinomycin remains the drug of choice for PPNG infections treated in the United States. Recommended treatment of spectinomycin-resistant PPNG cases remains 2 g cefoxitin, plus 1 g probenicid or 1 g cefotaxime (6). surveillance system, the occurrence and distribution of this outbreak can be readily described.

Despite this outbreak, spectinomycin remains the drug of choice for PPNG infections treated in the United States. Recommended treatment of spectinomycin-resistant PPNG cases remains 2 g cefoxitin, plus 1 g probenicid or 1 g cefotaxime (6).

References

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

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

  3. CDC. Spectinomycin-resistant B-lactamase-producing Neisseria gonorrhoeae--England. MMWR 1982;31:495-6, 501.

  4. CDC. Spectinomycin-resistant Neisseria gonorrhoeae--worldwide. MMWR 1982;31:632, 637-8.

  5. Division of Venereal Disease Control, CDC. PPNG data system.

  6. CDC. Sexually transmitted diseases: treatment guidelines, 1982. MMWR 1982;31(2 suppl):39S.

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