The number of gonorrhoea isolates showing resistance to ciprofloxacin, the recommended first line treatment for the infection, has grown to 10%, according to a study carried out in England and Wales by the Communicable Disease Surveillance Centre. The findings are published in the April 11 edition of Communicable Disease Review.
The study was carried out in the summer of 2002, when 26 sentinel clinics throughout England and Wales provided consecutive isolates for antimicrobial susceptibility testing.
The study found that prevalence of ciprofloxacin resistance had grown from 2.1% in 2000 to 9.8% in 2002 (p
The highest prevalence was reported in Yorkshire (18.4%) and the East Midlands (16.5%) and the lowest prevalence in the North East (2.8%) and South West of England (6.6%). Increases in resistance occurred in men and women, and did not appear to be linked to sexual orientation or travel abroad. Previous rounds of testing, in 2001 and prior, had consistently found that ciprofloxacin resistance was significantly more common in men than women and in heterosexual men compared to gay men. This week’s findings suggest that the problem is now affecting all groups with equal severity.
Dr Sarah Barrett of Brighton and Sussex University Hospital told aidsmap that a local audit had revealed that 16% of gonorrhoea cases between July and October 2002 were ciprofloxacin-resistant, causing the hospital to change its local protocol for first-line treatment.
“We found no consistent pattern, such as overseas travel, which would allow us to determine when it might be best to avoid ciprofloxacin, so we have changed our regimen to cefixime 400mg”.
Experts throughout the UK say the reasons for the upsurge in ciprofloxacin resistance are unclear, although the misuse of ciprofloxacin to self-treat other infections, especially in the presence of undiagnosed gonorrhoea, together with high rates of undiagnosed gonorrhoea may be encouraging the emergence of strains with reduced susceptibility to a range of antibiotics.
Although overseas travel did not emerge as a significant factor in predicting who had ciprofloxacin resistant gonorrhoea in the national survey, ciprofloxacin resistance is widespread in the Far East, Australia and the Pacific regions, and recent reports suggest that it is also spreading into the West Coast of the United States.
Further information on this website
Dramatic increase in ciprofloxacin-resistant gonorrhoea in England and Wales. CDR Weekly April 10 2003.