Biomedical subjects

J S Knapp

Publications and source records attributed to J S Knapp.

At least 109 records · Page 6Linked to original sources

PubMed1975

Disseminated gonococcal infections caused by Neisseria gonorrhoeae with unique nutritional requirements.

Disseminated gonococcal infection occurs in 1%-3% of patients with gonorrhea in Seattle. Most strains of Neisseria gonorrhoeae recovered from patients with disseminated gonococcal infection are susceptible to less than or equal to 0.015 mug of penicillin G/ml. Strains susceptible to less than or equal to 0.015 mug/ml, whether isolated from patients with disseminated gonococcal infection or from those with uncomplicated infection, did not grow on chemically defined medium prepared with several lots of agar, whereas less susceptible isolates grew well. Use of methanol-extracted nontoxic agar permitted growth of the penicillin-susceptible strains and demonstrated that all of them required arginine, hypoxanthine, and uracil (Arg-Hyx-Ura-) for growth. These Arg-Hyx-Ura- strains accounted for 89% of the cases of disseminated gonococcal infection in Seattle, 38% of uncomplicated infections in Seattle, 18% of infections in Milwaukee, and none of 104 uncomplicated gonococcal infections acquired in the Philippines and Taiwan, where disseminated gonococcal infection is unusual. Regional variations in the prevalence of these Arg-Hyx-Ura- strains may correlate with regional variations in the incidence of disseminated gonococcal infection. The genetic, physiologic, and immunologic bases for concurrence of penicillin and agar susceptibility. Arg-Hyx-Ura- phenotype, and association with disseminated gonococcal infection remain undefined, as do host factors that determine whether or not disseminated gonococcal infection will result in patients infected by such strains.

Adult↗

PubMed1975

Reevaluation of bacteriocinogeny in Neisseria gonorrhoeae.

Bacteriocin typing has been described previously and proposed for typing gonococci. A survey has been made of 150 strains of N. gonorrhoeae from various places to determine the feasibility of a gonocin typing system. All strains were found to produce an inhibitory substance which inhibited all strains of gonococci tested, one strain of Neisseria flavescens, two strains of Neisseria meningitidis, as well as the producing strain itself. The inhibitory activity was enhanced by supplementary glucose, reduced by supplementary serum, and unaffected by the addition of HEPES buffer, by the temperature of incubation, or by the exposure of potential producer strains to sublethal concentrations of mitomycin C. This nonspecific inhibitory activity differed from that of a putative bacteriocin produced by a strain of N. meningitidis, in that the latter inhibited most other meningococci but not the producer strain itself. Bacteriocinogeny has not yet been convincingly demonstrated in N. gonorrhoeae, and gonocin typing has not yet been shown to be feasible. Production of the nonspecific inhibitor may have obscured past attempts to demonstrate type-specific gonococcal bacteriocin.

Bacteriocins↗

PubMedDate not supplied

Correlation of auxotype and penicillin susceptibility of Neisseria gonorrhoeae with sexual preference and clinical manifestations of gonorrhea.

Strains of Neisseria gonorrhoeae requiring arginine, hypoxanthine, and uracil (Arg-Hyx-Ura-) are highly susceptible to penicillin G, and have been associated with asymptomatic urethral infection and disseminated gonococcal infection (DGI). The authors recovered Arg-Hyx-Ura- strains from 48% of 282 heterosexual men and women, versus only 9% of 69 homosexual or bisexual men (P less than 0.0001). In a separate population of consecutive men with urethral gonococcal infections, urethral discharge was absent in 0 of 96 homosexual men, versus 18 of 261 heterosexual men (P less than 0.025). Homosexual men accounted for none of 41 cases of DGI in men in 1970--1973, compared with 35% of men with uncomplicated gonorrhea in 1978. These findings suggest that asymptomatic urethral gonococcal infection and DGI are uncommon in homosexual men, perhaps because infection with Arg-Hyx-Ura- strains is relatively uncommon. Screening cultures of urethral specimens for N. gonorrhoeae had a low yield among homosexual men in the population studied. Strains of N. gonorrhoeae recovered from homosexual men were significantly more resistant to penicillin than were isolates from heterosexual subjects; this was true even for non-Arg-Hyx-Ura-strains. This difference may help to explain the lesser efficacy of ampicillin in treatment of rectal gonococcal infection in homosexual men.

Adult↗

PubMedDate not supplied

Serogrouping of Neisseria gonorrhoeae: correlation of serogroup with disseminated gonococcal infection.

Gonococci can be divided into serogroups WI, WII, and WIII by coagglutination. To assess the clinical correlation of serogroups of gonococci, we studied isolates of gonococci from patients with disseminated and uncomplicated gonococcal infections in three cities in the United States. Strains of Neisseria gonorrhoeae belonging to serogroup WI represented 85 (84%) of 101 isolates from patients with disseminated gonococcal infection (DGI) and 68 (40%) of 168 isolates from patients with uncomplicated gonorrhea (P less than .001). The auxotype Arg-, Hyx-, Ura- (AHU) represented 62 (61%) of 101 isolates from DGI and 54 (32%) of 168 isolates from uncomplicated infection (p less than .001); all AHU isolates were serogroup WI. Among other auxotypes, WI strains represented 25 (64%) of 39 isolates from patients with DGI and 14 (12%) of 114 from uncomplicated infections (P less than .001). In Atlanta only, 13 (34%) of 38 isolates from DGI were AHU, but 31 (82%) were serogroup WI (P less than .001). Thus gonococci of serogroup WI are associated with DGI in these cities of the United States, and this correlation appears to be independent of auxotype. Serogroup WI is correlated with serum resistance.

Black People↗

PubMedDate not supplied

Auxotype/serovar diversity and antimicrobial resistance of Neisseria gonorrhoeae in two mid-sized American cities.

To characterize the prevalence and heterogeneity of Neisseria gonorrhoeae with chromosomally mediated resistance to penicillin G or tetracycline.HCl in Seattle, Washington, and Denver, Colorado, we auxotyped, serotyped, and determined the MICs of penicillin G and tetracycline for gonococcal isolates collected in both cities during 1984. In Seattle 37 (18%) and ten (5%) of 205 isolates had MICs for penicillin G of greater than or equal to 1.0 and greater than or equal to 2.0 micrograms/ml, respectively; in Denver eight (3%) of 240 isolates had MICs for penicillin of 1.0 microgram/ml, and none had MICs of greater than 1.0 microgram/ml. For tetracycline.HCl, 107 (52%) and 38 (19%) of Seattle isolates had MICs of greater than or equal to 1.0 and greater than or equal to 2.0 micrograms/ml, respectively, while in Denver the respective figures were 111 (46%) and 48 (20%). In each city, antimicrobial resistance was present in a number of auxotype/serovar (A/S) classes: isolates with MICs for penicillin G of greater than or equal to 1.0 microgram/ml were identified in 15 of 49 A/S classes in Seattle and in five of 49 A/S classes in Denver. These data indicate that chromosomal resistance to penicillin G and tetracycline.HCl varies geographically in prevalence and is a heterogeneous phenomenon involving multiple gonococcal strains.

Colorado↗

PubMedDate not supplied

Penicillinase-producing Neisseria gonorrhoeae in Dade County, Florida: phenotypic characterization of isolates from 1983, 1984, and 1986.

Penicillinase-producing strains of Neisseria gonorrhoeae (PPNG) have been endemic in Miami, Florida, since 1981. Strains of PPNG isolated in Miami during 1983 (60 isolates), 1984 (41 isolates), and 1986 (107 isolates) were characterized by plasmid content, auxotype/serovar (A/S) class, and susceptibility to antimicrobial agents. In 1986, 95 isolates (89%) possessed the 3.2-Megadalton (MDa) beta-lactamase plasmid; 36 (34%) of these isolates also possessed the 24.5-MDa conjugative plasmid. These results contrast with those from 1984, when 37 PPNG isolates (90%) possessed the 4.4-MDa plasmid, and most possessed the 24.5-MDa conjugative plasmid. This in turn was a reversal of the pattern seen in 1983, when only 42 (69%) possessed the 3.2-MDa plasmid, and the conjugative plasmid was rare. In 1983 and 1986, isolates possessing the 4.4-MDa plasmid were more resistant to penicillin than were isolates containing the 3.2-MDa plasmid. All isolates were susceptible to spectinomycin and ceftriaxone. In early 1986, two A/S classes accounted for 66% of all isolates. Pro/IA-1,2 and Pro/IB-2 accounted for 31 (29%) and 40 (37%), respectively, and were isolated during every week in early 1986. In contrast, isolates belonging to 14 and six A/S classes possessing the 3.2- and 4.4-MDa beta-lactamase plasmid, respectively, were isolated sporadically. The composition of the PPNG strain population in Miami is dynamic, a factor that may have important implications for the use of traditional disease intervention strategies.

Disease Outbreaks↗

PubMedDate not supplied

Trends in resistance of Neisseria gonorrhoeae to antimicrobial agents in the United States.

Resistance of Neisseria gonorrhoeae to antimicrobial agents is increasing in the United States. The number of cases of gonorrhea caused by beta-lactamase-producing strains of N. gonorrhoeae (PPNG) increased for the second consecutive year, and 16,608 were reported in 1986; these accounted for greater than 1.6% of all cases of gonorrhea. PPNG is endemic in Florida, New York City, and Los Angeles, and these areas may serve as foci for spread of PPNG strains in the United States. In 1985 N. gonorrhoeae strains that exhibited high-level resistance to tetracycline (TRNG; MIC, greater than or equal to 16.0 micrograms/ml) were reported. Tetracycline resistance was due to the tetM determinant in a 25.2-MDa tetM-conjugative plasmid. The prevalence of TRNG infections was greater than 4% in at least two communities. Strains with chromosomally-mediated resistance to several antimicrobial agents have been isolated more often; 399 cases were reported during the first half of 1986. Spectinomycin-resistant strains have been isolated in several cities, and strains with decreased susceptibility to ceftriaxone have been isolated. Phenotypic characterizations of strains of N. gonorrhoeae by auxotype and serovar, plasmid content, and antibiograms have permitted more detailed study of the heterogeneity and dynamics of strain populations. Characterization of outbreaks caused by resistant strains and surveillance of regional and temporal changes in antimicrobial resistance in gonococcal strain populations may be used in design of innovative strategies for gonorrhea control and for making anticipatory changes in recommended therapies for gonorrhea.

Anti-Bacterial Agents↗

PubMedDate not supplied

Laboratory methods for the detection and phenotypic characterization of Neisseria gonorrhoeae strains resistant to antimicrobial agents.

Strains of Neisseria gonorrhoeae that are resistant to antimicrobial agents have emerged after the use of these agents. Antimicrobial resistance can be either chromosomal or plasmid-mediated. Arbitrary methods, both agar-dilution and disk-diffusion procedures, have been developed to measure the in-vitro antimicrobial resistance of gonococcal isolates. These methods must be performed by use of standard procedures and the quality of the process must be controlled by use of reference strains with known susceptibilities. Results of antimicrobial susceptibility tests must be interpreted with caution. Phenotypic characterization of gonococcal isolates using auxotyping, serotyping, and plasmid content has permitted us to compare susceptible and resistant strains in an effort to understand the diversity of antimicrobial resistance in N. gonorrhoeae and the dynamics of epidemics of gonorrhoea associated with resistant strains.

Anti-Bacterial Agents↗

PubMedDate not supplied

Frequency in the United States of non-beta-lactamase-producing strains of Neisseria gonorrhoeae possessing the 24.5-Mdal conjugative plasmid.

We characterized 475 non-beta-lactamase-producing gonococcal isolates from five U.S. cities by auxotype, serovar, and plasmid content to determine the frequency of isolates with the 24.5-Mdal gonococcal conjugative plasmid. A total of 150 (32%) of all isolates possessed the 24.5-Mdal plasmid; these isolates represented between 10% and 53% of isolates from each city. Isolates possessing the 24.5-Mdal plasmid belonged to 45 (56%) of 81 auxotype/serovar (A/S) classes, or between 24% and 70% of the A/S classes isolated in each city. Overall, a higher proportion of strains isolated in the southern cities possessed the 24.5-Mdal plasmid than did those from northeastern or northwestern cities. These strains appear to have spread independently of the spread of beta-lactamase-producing Neisseria gonorrhoeae strains. The prevalence of N. gonorrhoeae strains with the 24.5-Mdal conjugative plasmid has increased substantially and may have important implications for the epidemiology of gonorrhea caused by beta-lactamase-producing strains.

Conjugation, Genetic↗

PubMedDate not supplied

Transfer frequency of various 25.2 Mdal tetracycline resistance plasmids in Neisseria gonorrhoeae.

We examined ten Neisseria gonorrhoeae strains, all of which carried the tetracycline resistant 25.2 Mdal plasmid, for their ability to act as donors in conjugation. All strains transferred the 25.2 Mdal plasmid and tetracycline resistance to the recipient N. gonorrhoeae strain F62 at a frequency that ranged from 10(-2) to 10(-7) per recipient. The four strains carrying the beta-lactamase plasmid and the 25.2 Mdal plasmid transferred the beta-lactamase plasmid at a frequency of 10(-6) to 10(-8) per recipient. The results indicate that most of the N. gonorrhoeae strains carrying the 25.2 Mdal plasmid can act as donors of this plasmid and can also mobilize the transfer of the 3.2 Mdal plasmid and the 4.4 Mdal plasmid to recipient strains.

Conjugation, Genetic↗

PubMedDate not supplied

Risk factors for infection with plasmid-mediated high-level tetracycline resistant Neisseria gonorrhoeae.

This study was done to determine whether the increase in high-level tetracycline resistant Neisseria gonorrhoeae (TRNG) was associated with increased tetracycline use. From 547 persons with positive cultures seen consecutively at a sexually transmitted disease (STD) clinic, 51 (9%) isolates were resistant to tetracycline. Of these 51 isolates, 37 (73%) had high-level resistance (TRNG) which was mediated by the tetM determinant located on a 25.2-megadalton plasmid. Women were twice as likely as men to have TRNG. Previous visits to an STD clinic and oral antibiotic use for a sexually transmitted disease within a one to five month period were used as surrogates for prior tetracycline use. Patients who had been to an STD clinic were almost twice as likely to have TRNG (RR = 1.9, 95% CI: 1.01, 3.46), and those who took an oral antibiotic had a relative risk of 1.8. The authors postulate that previous tetracycline use selects for tetM-containing microorganisms in the genitourinary tract that, at the time of gonococcal infection, have the ability to transfer the determinant to N. gonorrhoeae. The above findings might have implications for modifying the current Centers for Disease Control (CDC) recommendation to prescribe tetracycline for suspected Chlamydia infection among patients with gonorrhea.

Adult↗

PubMedDate not supplied

Acquisition of beta-lactamase and TetM-containing conjugative plasmids by phenotypically different strains of Neisseria gonorrhoeae.

beta-lactamase plasmids confer high-level penicillin resistance on strains of Neisseria gonorrhoeae and may be mobilized between strains by conjugative plasmids. The authors examined 32 isolates belonging to 23 auxotype/serovar (A/S) classes to determine the frequency with which they acquired the 4.4-, 3.2-, and 3.05-megadalton (Mdal) beta-lactamase plasmids, respectively. The 3.05-Mdal beta-lactamase plasmid was not acquired by any isolate. Each of 22 isolates possessing only the 2.6-Mdal plasmid or both the 2.6- and 24.5-Mdal plasmids acquired the 4.4- and 3.2-Mdal plasmids at similar frequencies, and 12 (55%) acquired the 4.4- or 3.2-Mdal plasmids at a frequency of greater than or equal to 10(-3) per input recipient; all transconjugants acquired the 24.5-Mdal conjugative plasmid. Among ten isolates that lacked the 2.6-Mdal plasmid (plasmidless), seven isolates that included five PAU/IB-2, -16 isolates acquired neither the 4.4- nor 3.2-Mdal plasmid; three non-PAU isolates acquired both the 4.4- and 3.2-Mdal plasmids (10(-2)-10(-5) per input recipient). All plasmidless isolates acquired the 25.2-Mdal TetM containing plasmid with frequencies ranging from 10(-1) to 10(-8) per input recipient. These data suggest that gonococcal strains possessing the 2.6-Mdal plasmid readily acquire the 4.4- and 3.2-Mdal beta-lactamase plasmids in vitro, whereas acquisition of these plasmids by strains lacking the 2.6-Mdal plasmid is strain dependent.

Conjugation, Genetic↗

PubMedDate not supplied

Distribution of the 3.05-Mdal "Toronto" beta-lactamase plasmid among penicillinase-producing isolates of Neisseria gonorrhoeae in the Far East.

One hundred and fifty-two beta-lactamase-producing Neisseria gonorrhoeae isolates from Japan (n = 25; 1983, 1985, 1986), Taiwan (n = 14; 1983, 1984), and the Republics of Singapore (n = 58; 1986, 1987) and the Philippines (n = 55; 1989) isolated from 1983 through 1989 were characterized by auxotype, serovar, and plasmid content to determine the distribution and diversity of penicillinase-producing N. gonorrhoeae (PPNG) strains possessing the 3.05-Mdal "Toronto" beta-lactamase plasmid. PPNG isolates possessing a 3.05-Mdal beta-lactamase plasmid were isolated in Japan (1/25: 4%), Taiwan (4/14: 29%), and the Republic of the Philippines (3/55: 5%); no PPNG isolates with the 3.05-Mdal plasmid were isolated in the Republic of Singapore. All isolates possessing the 3.05-Mdal plasmid also possessed a 24.5-Mdal conjugative plasmid and belonged to the auxotype/serovar class, Proto/IB-1. Studies with five isolates possessing the 3.05-Mdal plasmid, and representing isolates from each country in which they were found, confirmed that the beta-lactamase plasmid in these strains could not be transferred to another gonococcal isolate by conjugation. PPNG isolates possessing the "Toronto" plasmid are widespread in the Far East; spread of these isolates may, however, be limited to the physical spread of a single strain.

Bacterial Typing Techniques↗

PubMedDate not supplied

Molecular epidemiology, based on plasmid profiles, of Haemophilus ducreyi infections in the United States. Results of surveillance, 1981-1990.

To determine the distribution and extent of temporal changes in Haemophilus ducreyi strains in the United States, 342 isolates of H. ducreyi collected in 18 urban areas in the United States between 1981 and 1990 were characterized by plasmid content. Isolates possessed either no plasmid (29.8%), the 5.7-Mdal plasmid (50.9%), both the 4.4- and 5.7-Mdal plasmids (6.1%), the 3.2-Mdal plasmid (12.9%), or a combination of 1.8-, 2.6-, 2.8-, and 3.2-Mdal plasmids (1 case out of 342). Isolates that possessed no plasmid or that possessed the 5.7-Mdal plasmid had the widest geographic distribution; only isolates from cities on the West Coast possessed the 3.2-Mdal plasmid. Evidence was found of temporal changes in H. ducreyi strain populations among isolates from both Tampa and New Orleans.

Epidemiologic Methods↗

PubMedDate not supplied

Diversity of isolates of penicillinase-producing Neisseria gonorrhoeae (PPNG) in Honolulu, Hawaii: 1982-1991.

BACKGROUND AND OBJECTIVES: Gonococcal infections caused by penicillinase-producing Neisseria gonorrhoeae (PPNG) isolates have increased in geographic distribution and prevalence. It was postulated that PPNG strains would become endemic in Honolulu and that, in turn, this city would serve as a reservoir for the introduction of PPNG strains into the continental United States. GOAL OF THIS STUDY: To assess the role of Honolulu as a reservoir for PPNG strains by assessing the diversity and persistence of PPNG strains between 1982 and 1991. STUDY DESIGN: A total of 432 PPNG strains were characterized by auxotype/serovar (A/S) class and plasmid content, and their distribution during the 10-year period was studied. RESULTS: Of 432 isolates, 373 (86.4%) possessed a 4.4-Mdal beta-lactamase plasmid; 39 (9.0%) possessed a 3.2-Mdal beta-lactamase plasmid; and 20 (4.6%) possessed a 3.05-Mdal beta-lactamase plasmid. A total of 53 A/S classes were identified. Asian, African, and Toronto PPNG strains belonged to 49 (92.5%), 15 (28.3%), and 11 (20.7%) A/S classes, respectively. Though all Toronto PPNG strains possessed a 24.5-Mdal conjugative plasmid, these plasmids could not be transferred by conjugation. Although some apparent microepidemics of PPNG strains were identified, most strains were isolated sporadically. CONCLUSIONS: A large number of different strains have been associated with PPNG infections in Honolulu, but there was no evidence that any strain persisted endemically during the study period. These observations have important implications for the design and assessment of community gonorrhea control strategies.

Conjugation, Genetic↗

PubMedDate not supplied

Plasmid-mediated antimicrobial resistance in Neisseria gonorrhoeae in Kingston, Jamaica: 1990-1991.

BACKGROUND AND OBJECTIVES: Gonococcal infections caused by antimicrobial-resistant strains of Neisseria gonorrhoeae have spread into many geographic areas and have increased in prevalence since the mid 1970s. Surveillance of antimicrobial-resistant gonococcal strains of Jamaica from 1981 to 1983 indicated that fewer than 3% of strains of produced beta-lactamase (penicillinase-producing Neisseria gonorrhoeae); approximately 4% of strains were resistant to penicillin, and 12% were resistant to tetracycline. GOAL OF THIS STUDY: To measure the frequency and nature of antimicrobial resistance in Neisseria gonorrhoeae isolates in Kingston, Jamaica, from 1990 to 1991 and to assess the effectiveness of prescribed treatment regimens. STUDY DESIGN: Urethral isolates of Neisseria gonorrhoeae from 116 heterosexual men with uncomplicated gonorrhea, representing 7.1% (116/1633) men attending the STD Comprehensive Health Centre from October 1990 through March 1991 who had positive Gram-stained smears, were characterized by auxotype, serovar, presence of the TetM determinant, and plasmid content. Antimicrobial susceptibilities to penicillin, cefoxitin, ceftriaxone, ciprofloxacin, tetracycline, and spectinomycin were determined by an agar dilution method. RESULTS: A total of 80.2% (93/116) of the isolates exhibited plasmid-mediated resistance to penicillin, tetracycline, or both: penicillinase-producing Neisseria gonorrhoeae (13/116; 11.2%), tetracycline-resistant Neisseria gonorrhoeae (25/116; 21.6%), and penicillinase-producing/tetracycline-resistant Neisseria gonorrhoeae, (55/116;47.4%). Isolates with chromosomally mediated resistance to penicillin, tetracycline, or both, accounted for 5.2% (6/116) of the isolates. Penicillinase-producing Neisseria gonorrhoeae, tetracycline-resistant Neisseria gonorrhoeae, and penicillinase-producing/tetracycline-resistant Neisseria gonorrhoeae belonging to multiple auxotype/serovar classes were isolated repeatedly through the study period. CONCLUSIONS: Infections caused by Neisseria gonorrhoeae exhibiting plasmid-mediated resistance to penicillin, tetracycline, or both, have become prevalent and endemic in Kingston, Jamaica. Therefore, all gonococcal infections should be treated with antimicrobial therapies known to be active against penicillin-resistant and tetracycline-resistant organisms to reduce gonorrhea transmission.

Bacterial Typing Techniques↗

PubMedDate not supplied

Laboratory diagnosis of sexually transmitted diseases in facilities within the United States. Results of a national survey.

BACKGROUND AND OBJECTIVES: The diagnosis of many sexually transmitted diseases (STD) requires laboratory testing. The authors assessed the effects of the introduction of new tests and regulations on STD testing. STUDY DESIGN: A questionnaire survey was mailed to a random sample of facilities listed in the STD Referral Database inquiring about tests offered, changes in testing, and reasons for changes. RESULTS: Responses from 405 facilities were analyzed. Most responding facilities collected specimens for nontreponemal tests for syphilis (352 of 405 [86.9%]). Since each facility's information was last updated, the number reporting testing for Chlamydia trachomatis rose from 160 of 405 (39.5%) to 288 of 405 (71.1%), but testing for gonorrhea and chancroid decreased (365 of 405 [90.1%] to 328 of 405 [81%], and 182 of 405 [44.9%] to 32 of 405 [7.9%], respectively). Of 364 responses to a question on changes in tests performed in the last 2 years, 249 (68.4%) reported no change, 81 (22.3%) reported an increase, and 37 (10.2%) reported a decrease. The most frequently added tests were nonculture tests for C. trachomatis (34 of 81 [42%]) and the most frequent reason for adding tests was targeted funding (25 of 81 [30.9%]). The most frequently discontinued tests were cultures and gram stains for gonorrhea (15 of 37 [40.5%]) and other in-house tests (9 of 37 [24.3%]). Most facilities that discontinued testing cited the Clinical Laboratory Improvement Act as the reason (34 of 37 [91.9%]; 95% confidence interval = 78.1%, 98.3%). CONCLUSIONS: The number of facilities testing for C. trachomatis has increased with funding and with the availability of nonculture tests, but the number of those testing for chancroid and gonorrhea has decreased. Implementation of the Clinical Laboratory Improvement Act may be associated with a decrease in the number of facilities performing tests for STD.

Clinical Laboratory Techniques↗

PubMedDate not supplied

Fluoroquinolone resistance in Neisseria gonorrhoeae.

Fluoroquinolones and broad-spectrum cephalosporins are the most effective antimicrobial agents for the treatment of gonorrhea. However, clinically significant resistance to fluoroquinolones has emerged in Neisseria gonorrhoeae. Fluoroquinolone-resistant strains account for approximately 10% of all gonococcal strains in Hong Kong and the Republic of the Philippines. As many as 50% of strains from some Far Eastern countries exhibit decreased susceptibility (intermediate resistance) to fluoroquinolones. Strains with intermediate resistance and clinically significant resistance are being isolated sporadically in North America, where resistant strains have been associated with an outbreak and with failure of infections to respond to treatment with doses of ciprofloxacin and ofloxacin recommended by the Centers for Disease Control and Prevention; strains exhibiting decreased susceptibility to these agents are endemic in at least one metropolitan area. Monitoring for fluoroquinolone resistance is now critical for ensuring adequate treatment of infections with resistant strains and for maximizing the time during which fluoroquinolones may be used to treat gonorrhea.

Anti-Infective Agents↗