title: A new sexually transmitted infection (STI) in Geneva? Ciprofloxacin-resistant Neisseria gonorrhoeae, 2002-2005.
abstract: BACKGROUND
  Neisseria gonorrhoeae (NG) resistant to ciprofloxacin (CR) was documented for the first time in Geneva in 2002 and increased from 7% that year to 47% in 2005. We describe NG cases during this period and compare characteristics of CR and ciprofloxacin susceptible (CS) cases.
  
  
  METHODS
  Geneva microbiological laboratories identified NG cases. Antimicrobial susceptibility testing (AST) was performed on a sample of reported cases. The attending physicians completed questionnaires on demographic and epidemiological characteristics. Risk exposures were assessed by comparing CR and CS cases using logistic regression.
  
  
  RESULTS
  238 NG cases were reported. Of 91 on which AST was performed, 23 (25%) were CR; 91% of these were male vs 87% of CS patients. Men having sex with men (MSM) represented 38% of CR cases compared with 31% of CS cases (p>0.05). Among CR cases 65% were Swiss compared with 56% of CS cases. Median age was 35 years for both. Casual sexual contacts were reported for 88% of CR cases and 72% of CS cases (p>0.05). The difference between CR and CS cases in terms of sexual activity outside Switzerland (50% and 19% respectively) remained significant after adjusting for sexual preference and nationality (OR: 7.0, CI 95: 1.99-24.6).
  
  
  CONCLUSIONS
  Although CR infection was more common among Swiss MSM, only sexual activity outside Switzerland was independently associated with CR. Physicians should request AST before treatment and reconsider first-line use of ciprofloxacin. Surveillance of gonococcal antimicrobial resistance is essential in monitoring epidemiologic trends and updating recommendations on first-line treatment.
authors.affiliation: General Directorate of Health, Geneva, Switzerland.
authors.forename: Brigitte
authors.initials: B
authors.lastname: Le Lin
authors.forename: Roberta
authors.initials: R
authors.lastname: Pastore
authors.forename: Nadia
authors.initials: N
authors.lastname: Liassine
authors.forename: Carmen
authors.initials: C
authors.lastname: Aramburu
authors.forename: Philippe
authors.initials: P
authors.lastname: Sudre
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000494:pharmacology* / Q000627:therapeutic use; D002939:Ciprofloxacin / Q000494:pharmacology* / Q000627:therapeutic use; D024881:Drug Resistance, Bacterial; D005260:Female; D006069:Gonorrhea / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D009344:Neisseria gonorrhoeae; D012307:Risk Factors; D012725:Sexual Behavior; D013557:Switzerland / Q000453:epidemiology
chemical_list: D000900:Anti-Bacterial Agents; D002939:Ciprofloxacin