title: Fluoroquinolone resistance among Neisseria gonorrhoeae isolates in Hawaii, 1990-2000: role of foreign importation and increasing endemic spread.
abstract: OBJECTIVE
  In 1999, an increase in ciprofloxacin-resistant Neisseria gonorrhoeae isolates was identified in Hawaii, prompting initiation of investigative studies.
  
  
  OBJECTIVE
  The goal of this study was epidemiologic evaluation of this increase.
  
  
  METHODS
  The authors conducted a review of laboratory data; case-series and case-control studies based on medical record review; and a prospective case-control study based on patient interviews.
  
  
  RESULTS
  A total of 10.4% (21 of 201) of gonococcal isolates from Hawaii in 2000 were ciprofloxacin-resistant compared with <1.5% per year from 1990 to 1997. From medical record review for patients diagnosed with ciprofloxacin-resistant N. gonorrhoeae infection from 1990 to 1999, 59% were Asian/Pacific Islanders and 91% were heterosexual. From review of 1998 and 1999 sexually transmitted disease (STD) clinic medical records, patients with ciprofloxacin-resistant N. gonorrhoeae were more likely to report recent foreign travel or a sex partner with recent foreign travel than patients with ciprofloxacin-susceptible N. gonorrhoeae (6 of 12 vs. 10 of 117, P <0.001), but 50% (6 of 12) acquired a ciprofloxacin-resistant strain locally from a partner with no recent travel. In 2000, 70% (7 of 10) of STD clinic patients with ciprofloxacin-resistant N. gonorrhoeae acquired their infection locally from partners with no reported recent travel.
  
  
  CONCLUSIONS
  Infections with ciprofloxacin-resistant N. gonorrhoeae are increasing and evolving in Hawaii.
authors.affiliation: Epidemic Intelligence Service, Epidemiology Program Office, Hawaii Department of Health, Honolulu, Hawaii. civerso@emory.edu
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Iverson
authors.forename: Susan A
authors.initials: SA
authors.lastname: Wang
authors.forename: Marie V
authors.initials: MV
authors.lastname: Lee
authors.forename: Roy G
authors.initials: RG
authors.lastname: Ohye
authors.forename: David L
authors.initials: DL
authors.lastname: Trees
authors.forename: Joan S
authors.initials: JS
authors.lastname: Knapp
authors.forename: Paul V
authors.initials: PV
authors.lastname: Effler
authors.forename: Norman P
authors.initials: NP
authors.lastname: O'connor
authors.forename: William C
authors.initials: WC
authors.lastname: Levine
mesh_terms: D000293:Adolescent; D000328:Adult; D016022:Case-Control Studies; D024881:Drug Resistance, Bacterial; D005006:Ethnicity / Q000706:statistics & numerical data; D005260:Female; D024841:Fluoroquinolones / Q000494:pharmacology*; D006069:Gonorrhea / Q000188:drug therapy / Q000453:epidemiology* / Q000208:ethnology / Q000209:etiology / Q000382:microbiology; D006254:Hawaii / Q000453:epidemiology; D006801:Humans; D007755:Laboratories, Hospital / Q000706:statistics & numerical data; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D009344:Neisseria gonorrhoeae / Q000187:drug effects*; D011446:Prospective Studies; D012189:Retrospective Studies; D012307:Risk Factors; D011795:Surveys and Questionnaires
chemical_list: D024841:Fluoroquinolones