title: Gonorrhea among men who have sex with men: outbreak caused by a single genotype of erythromycin-resistant Neisseria gonorrhoeae with a single-base pair deletion in the mtrR promoter region.
abstract: During 1995-1997, an outbreak of 66 cases of gonorrhea caused by an erythromycin-resistant (Ery(r); MIC >/=1.0 microgram/mL) prototrophic (proto) auxotype IB-1 serovar of Neisseria gonorrhoeae occurred in King County, Washington; 65 cases involved men who have sex with men (MSM), which accounted for approximately 37% of infections among MSM during this period. Isolates from 19 of these 65 cases of infection were analyzed by DNA sequencing of the polymerase chain reaction-amplified promoter region of the mtrR gene and by pulsed-field gel electrophoresis (PFGE) analysis of genomic DNA after NheI and SpeI digestion. Eighteen of the 19 isolates had a 1-bp A/T deletion in a 13-bp inverted repeat of the mtrR promoter region and shared a single PFGE type. Among MSM who provided data about sexual behavior, 37 (64%) of 58 MSM infected by the proto/IB-1 Ery(r) strain reported having >2 sex partners during the past 60 days, compared with 32 (30%) of 106 MSM infected by other strains (P<.001). This clonal outbreak of gonorrhea illustrates the ongoing need for behavioral preventive interventions among MSM.
authors.affiliation: Neisseria Reference Laboratory, Center for AIDS and STD, University of Washington, Seattle, WA, USA.
authors.forename: M
authors.initials: M
authors.lastname: Xia
authors.forename: W L
authors.initials: WL
authors.lastname: Whittington
authors.forename: W M
authors.initials: WM
authors.lastname: Shafer
authors.forename: K K
authors.initials: KK
authors.lastname: Holmes
mesh_terms: D001426:Bacterial Proteins; D004196:Disease Outbreaks; D004352:Drug Resistance, Microbial; D004917:Erythromycin / Q000494:pharmacology*; D005287:Ferredoxin-NADP Reductase; D017353:Gene Deletion; D005838:Genotype; D006069:Gonorrhea / Q000453:epidemiology* / Q000821:virology; D018451:Homosexuality, Male; D006801:Humans; D008297:Male; D009344:Neisseria gonorrhoeae / Q000145:classification / Q000187:drug effects / Q000235:genetics*; D011401:Promoter Regions, Genetic; D012097:Repressor Proteins / Q000235:genetics*
chemical_list: D001426:Bacterial Proteins; D012097:Repressor Proteins; C087450:mtrR protein, Neisseria gonorrhoeae; D004917:Erythromycin; C111241:methionine synthase reductase; D005287:Ferredoxin-NADP Reductase