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).
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.
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