CDC surveillance project: gonococcal resistance to quinolones on the rise; National rate increases from 2.2% to 4%.(News)

PHILADELPHIA -- The rate of fluoroquinolone resistance in Neisseria gonorrhoeae doubled from 2.2% in 2002 to greater than 4% in 2003, and resistant isolates are now surfacing at several sites around the country, according to an official with the Centers for Disease Control and Prevention.

In the past, the problem of quinolone-resistant Neisseria gonorrhoeae (QRNG) was limited to Hawaiii and California, "but we now have big increases in Massachusetts, New Hampshire, New York City, Seattle, and Washington state. We also have increased frequency of resistance to a lesser extent in Chicago, Philadelphia, Las Vegas, and many other cities and states," reported Dr. Susan Wang, national coordinator, gonococcal resistance, in the division of STD prevention at the CDC.

According to preliminary estimates of 2003 data, the national rate of QRNG is about 4%, while the rate is about 12% in Hawaii, 19% in California, and 14% in Massachusetts, she said at a conference on STD prevention sponsored by the CDC.

It's not clear how widespread the problem is, because only a limited number of cities and counties participate in the CDC-sponsored Gonococcal Isolate Surveillance Project (GISP), which monitors the susceptibilities of N. gonorrhoeae strains to antimicrobial agents, including ciprofloxacin and cephalosporins.

"In most places, susceptibility testing is not done at the local level. So you and your local health department may not know if gonococcal resistance is a problem for your area, unless you are in a GISP city," Dr. Wang said.

GISP sites include Albuquerque; Atlanta; Baltimore; Birmingham, Ala.; Chicago; Cincinnati; Cleveland; Dallas; Denver; Detroit; Greensboro, N.C.; Honolulu; Los Angeles; Las Vegas; Long Beach County, Calif.; Miami; Minneapolis; New Orleans; Oklahoma City; Orange County, Calif.; Philadelphia; Phoenix, Ariz.; Portland, Ore.; San Diego; San Francisco; Seattle; and St. Louis.

"The prevalence of QRNG in women is increasing but is generally lower than in men who have sex with men [MSM]," Dr. Wang said. The latter group accounts for a "big portion" of the cases of QRNG. "According to 2002 data, in New York City, Seattle, and Massachusetts, QRNG is especially emerging in MSM," she said.