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Epidemiologic Notes and Reports Penicillinase-Producing Neisseria gonorrhoeae -- United States, 1986

In 1986, 16,608 cases of infection caused by penicillinase-producing Neisseria gonorrhoeae (PPNG) were reported to CDC. This represented 1.8% of all reported gonorrhea and was a 90% increase over the 8,724 cases reported in 1985. PPNG incidence has risen fourfold since 1984. Sixty-four percent of cases in 1986 occurred in the three areas previously identified as hyperendemic--Florida, New York City, and Los Angeles (1).

New York City experienced the greatest proportional increase of PPNG incidence despite its policy of treating all patients diagnosed with gonorrhea in the public clinics with antimicrobials effective against PPNG. In 1986, 3,986 cases were reported, compared with the 1,567 cases reported in 1985--a 154% increase. The proportion of total gonorrhea attributable to PPNG was 4.3%. Outbreaks have been identified in suburban areas of New York City located on Long Island and in New Jersey and Westchester County.

In Florida, 5,629 PPNG cases were reported--34% of the national total. In Dade County (Miami), Florida, the most severely affected county in the country, reported cases of PPNG increased from 2,455 in 1985 to 2,648 in 1986--an 8% increase. In 1986, the proportion of total gonorrhea attributable to PPNG in Dade County was 22%. Excluding Dade County, reported cases in Florida increased from 1,710 in 1985 to 2,981 in 1986--a 74% increase. The number of counties in Florida reporting hyperendemic PPNG (a proportion of PPNG 3%) rose from 16 counties in 1985 to 31 counties in 1986. These counties contain 69% of the state's population.

In Los Angeles, the number of cases increased from 488 in 1985 to 942 in 1986--a 93% increase. Another center of PPNG activity, probably representing secondary spread, has also been identified in suburban Orange County. Reported by J Hill, J Witte, MD, J Wroten, MH Wilder, MD, Acting State Epidemiologist, Florida Dept of Health and Rehabilitative Svcs; S Fannin, MD, Los Angeles Health Dept; S Joseph, MD, J Miles, S Schultz, MD, New York City Health Dept; Div of Sexually Transmitted Diseases, Center for Prevention Svcs, CDC.

Editorial Note

Editorial Note: The incidence of antibiotic-resistant gonorrhea, and PPNG in particular, continues to increase and is spreading to previously unaffected areas. In earlier PPNG outbreaks, travel to PPNG endemic areas and prostitute contact were cited as risk factors for infection (2). While these factors may play an important role in the spread of PPNG disease to areas previously free of disease, once PPNG becomes endemic, it has the same epidemiologic characteristics as endemic, antibiotic-sensitive gonorrhea. PPNG patients have been predominantly inner-city residents, members of ethnic minority groups, and heterosexuals. Although high-risk groups for gonorrhea have included homosexual men, PPNG outbreaks among homosexual men are rare. The reasons for this are not entirely clear. Recent evidence from a CDC study in Miami has associated PPNG infection with inappropriate use of antibiotics (3).

Patients with inadequately treated PPNG infection are at high risk for complications. Women are especially at high risk for pelvic inflammatory disease. PPNG is effectively treated with ceftriaxone or spectinomycin, in doses recommended in the "1985 STD Treatment Guidelines" (4).

Once antibiotic-resistant gonorrhea becomes endemic, eradication is extremely difficult; it is also expensive. In these areas, all patients with a presumptive diagnosis of gonorrhea should be treated with either ceftriaxone or spectinomycin. Comprehensive recommendations for prevention, surveillance, diagnosis, and control of antibiotic-resistant gonorrhea have been recently developed by CDC in consultation with an expert advisory panel and are currently being reviewed by state and local health officials. These will be published later this spring as an MMWR supplement.


  1. CDC. Penicillinase-producing Neisseria gonorrhoeae--United States, Florida. MMWR 1986;35:12-4.

  2. Jaffe HW, Biddle JW, Johnson SR, Wiesner PJ. Infections due to penicillinase-producing Neisseria gonorrhoeae in the United States: 1976-1980. J Infect Dis 1981;144:191-7.

  3. Zenilman JM, Bonner M, Sharp K, Alexander ER. Penicillinase-producing Neisseria gonorrhoeae (PPNG) in Miami: etiologic roles of core group transmitters and of the illicit use of antibiotics (Abstract). New Orleans: 26th Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC), 1986.

  4. CDC. 1985 STD treatment guidelines. MMWR 1985;34(4S).

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