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New gonorrhoea strains are resistant to antibiotics

BMJ 2006; 333 doi: (Published 19 October 2006) Cite this as: BMJ 2006;333:825
  1. Caroline White
  1. London

    The number of strains of gonorrhoea that are resistant to antibiotics has continued to increase in England and Wales, despite recommended changes to first line treatment. Gonorrhoea is the second most commonly transmitted bacterial sexual infection in the United Kingdom.

    Figures released by the Health Protection Agency last week indicate considerable regional variations in levels of resistance and sharp increases in resistance among gay men and men who had sexual contact while abroad.

    The report was based on results of tests on more than 1600 isolates—mostly from specimens from genitourinary medicine clinics—collected over three months in 2005 in England and Wales as part of the agency's annual surveillance programme.

    More than one in five isolates (22%) were resistant to the fluoroquinolone ciprofloxacin, up from 14% in 2004. In all regions at least 10% of isolates were resistant to ciprofloxacin, but the percentage was highest in the south east of England at 42%.

    Resistance to penicillin also rose, from 11% of isolates in 2004 to 18% in 2005, but ranged from zero in the east of England to 25% in London. Much smaller rises were reported for tetracycline (4%) and azithromycin (0.4%).

    The number of diagnoses of gonococcal infections have been falling since 2003, but the number among gay men rose by 8% between 2004 and 2005. Ciprofloxacin resistance was four times higher among gay men than heterosexual men and rose from 24% to 42%.

    Sexual contact abroad significantly increased the chances of infection with a resistant strain of gonorrhoea. Ciprofloxacin resistance is above 90% in several Asian countries and above 50% in parts of Europe, says the report.

    Ciprofloxacin resistance was more than 49% among heterosexual men who had had sex while abroad but just over 6% among men who had not.

    Levels of chromosomally mediated resistance also more than doubled, from 10% to 26%. Isolates from gay men who had had sex while abroad were almost twice as likely to show this increased resistance than isolates from men who had not.

    The cephalosporins ceftriaxone and cefixime are now recommended as the first line treatment for gonorrhoea, but fluoroquinolones were prescribed to almost one in five people with gonorrhoea in 2005, including 17% of gay men—a finding that the report describes as “particularly worrying.”

    Catherine Ison, who led the research, said that the findings gave cause for concern. “We're at a critical point, because there are not many alternative antimicrobials around. [Gonorrhoea] is especially adept at developing resistance … We need to keep pushing the safer sex message.”

    Professor Ison added that the prevalence of gonococcal resistance in the wider community was likely to be higher than before but that few such samples were submitted to the surveillance programme.

    “We need to address this, but the resource implications are massive,” she said. “And there are ethical implications. The information we would need is not routinely collected in primary care,” she said.

    GRASP, The Gonococcal Resistance to Antimicrobials Surveillance Programme: Annual Report, 2005 is available at

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