[The rise in fluoroquinolone-resistant Neisseria gonorrhoeae among people attending the Municipal Health Service's clinic for sexually transmitted diseases in Amsterdam, the Netherlands; cefotaxime now first-choice treatment for uncomplicated gonorrhoea].
OBJECTIVE
To report the incidence of gonorrhoea and the development of resistance to Neisseria gonorrhoeae among attendees at the Municipal Health Service's STD-clinic in Amsterdam, The Netherlands, 2000-2003.


METHODS
Descriptive.


METHODS
Urethral or cervical swabs for culture for N. gonorrhoea were taken from attendees at the STD-clinic. Depending on reported sexual techniques throat and rectal swabs were also taken. The disk diffusion technique in combination with a beta-lactamase test were used for sensitivity testing. RESULTS. The number of Neisseria gonorrhoeae (NG) isolates collected at the Amsterdam Municipal Health Service's STD-clinic decreased from 1047 in 2002 to 772 in 2003. The number of fluoroquinolone-resistant NG (FRNG) isolates rose from 3 in 2000 to 56 in 2003 (p < 0.001). FRNG isolates amongst men who have sex with men increased from 1 in 568 isolates (0.2%) in 2000 to 50 in 478 isolates (10.5%) in 2003 (p < 0.001). Amongst heterosexual men, FRNG rose from 2 per 275 (0.7%) in 2000 to 16 per 297 (5.4%) in 2002 and dropped to 6 per 190 (3.4%) in 2003 (p = 0.146). No FRNG isolates were found in women in 2003 (2000: 0/180 (0.0%); 2001: 2/160 (1.3%); 2002: 4/183 (2.2%).


CONCLUSIONS
The recent incidence of FRNG among men who have sex with men to over 5% makes ciprofloxacin and other fluoroquinolones obsolete as the first-choice treatment option for uncomplicated gonorrhoea if no antibiogram is available. It is advised to use cefotaxim when an antibiogram is not available (yet).
Kolader
M
M
GG&GD, Nieuwe Achtergracht 100, 1018 WT Amsterdam.
Peerbooms
P G H
PG
Vader
P C van Voorst
PC
van Bergen
J E A M
JE
Fennema
J S A
JS
de Vries
H J C
HJ
D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use*; D002439:Cefotaxime / Q000627:therapeutic use*; D024881:Drug Resistance, Bacterial; D005260:Female; D024841:Fluoroquinolones / Q000494:pharmacology*; D006069:Gonorrhea / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology; D018451:Homosexuality, Male; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D009344:Neisseria gonorrhoeae / Q000187:drug effects*; D009426:Netherlands / Q000453:epidemiology; D012307:Risk Factors; D012725:Sexual Behavior
D000900:Anti-Bacterial Agents; D024841:Fluoroquinolones; D002439:Cefotaxime