title: Using strain typing to characterise a fluoroquinolone-resistant Neisseria gonorrhoeae transmission network in southern California.
abstract: OBJECTIVE
  We investigated the initial outbreak of fluoroquinolone-resistant Neisseria gonorrhoeae (QRNG) in southern California with analysis of transmission using strain typing.
  
  
  METHODS
  Surveillance for QRNG was conducted between 2000 and 2002 in southern California, including epidemiology and strain typing by a combination of antibiogram, auxotype, serovar, Lip type and amino acid alteration patterns in the quinolone-resistance determining region of GyrA and ParC. Combining epidemiological data with strain typing, we describe the emergence of QRNG outbreak strains using risk factor analysis and transmission networks.
  
  
  RESULTS
  Two outbreak strains accounted for 82% of isolates. Both strains required proline, were Lip type 17c, had amino acid alterations 91> Phe in GyrA and 87> Arg in ParC, but they differed by their serovar, IB-3C8 versus IB-2H7, 2G2. Outbreak strains were positively associated with men who have sex with men (MSM), adjusted odds ratio (AOR) 23.9 (95% confidence interval (CI) 2.2 to 261) and negatively associated with travel history: AOR 0.05, (95% CI 0.0 to 0.6). Network analysis demonstrated that 17 cases were connected by sexual contacts and/or public venues including bars, bathhouses/sex clubs, and internet sites.
  
  
  CONCLUSIONS
  QRNG may have become established among Californian MSM through an identified transmission network of southern Californian bars, bathhouses and internet sites.
authors.affiliation: California Department of Public Health, Sexually Transmitted Diseases (STD) Control Branch, Richmond, California, USA. shmorris@ucsd.edu
authors.forename: S R
authors.initials: SR
authors.lastname: Morris
authors.forename: J S
authors.initials: JS
authors.lastname: Knapp
authors.forename: D F
authors.initials: DF
authors.lastname: Moore
authors.forename: D L
authors.initials: DL
authors.lastname: Trees
authors.forename: S A
authors.initials: SA
authors.lastname: Wang
authors.forename: G
authors.initials: G
authors.lastname: Bolan
authors.forename: H M
authors.initials: HM
authors.lastname: Bauer
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002140:California / Q000453:epidemiology; D004352:Drug Resistance, Microbial; D024841:Fluoroquinolones / Q000627:therapeutic use*; D006069:Gonorrhea / Q000188:drug therapy* / Q000453:epidemiology / Q000635:transmission; D018451:Homosexuality, Male / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D009344:Neisseria gonorrhoeae
chemical_list: D000900:Anti-Bacterial Agents; D024841:Fluoroquinolones