title: Rapid change in the ciprofloxacin resistance pattern among Neisseria gonorrhoeae strains in Nuuk, Greenland: time to reconsider preventive and treatment strategies.
abstract: OBJECTIVE
  Sexually transmitted infections (STIs), including infections with Neisseria gonorrhoeae (GC), are highly incident in Greenland. Since January 2011, GC testing has been performed on urine with nucleic acid amplification tests (NAATs) by strand displacement amplification (Becton Dickinson ProbeTec). Monitoring of GC antibiotic susceptibility by culture was introduced in Nuuk in 2012. Until 2014, no cases of ciprofloxacin-resistant GC strains were reported. In this paper, we report the finding of ciprofloxacin-resistant GC and describe the most recent incidence of GC infections in Greenland.
  
  
  METHODS
  The number of urine NAATs and culture-positive swabs from January to October 2014 were obtained from the Central Laboratory at Queens Ingrid's Hospital in Nuuk and stratified on gender, place and period of testing. Incidence rates were estimated as number of urine NAAT * (12/10) per 100,000 inhabitants. Men in Nuuk with a positive NAAT for GC were encouraged to provide a urethral swab for culture and susceptibility testing.
  
  
  RESULTS
  From January to October 2014, a total of 5,436 urine GC NAATs were performed on patients from Nuuk and 9,031 from the rest of Greenland. Of these, 422 (8%) and 820 (9%) were positive, respectively. From January to August, 6 (15%) cultures from Nuuk were ciprofloxacin resistant while in September and October, 26 (59%) were ciprofloxacin resistant (p<0.01). In total, 35 (40%) of 88 culture-positive isolates showed ciprofloxacin resistance. GC incidence in Nuuk was 3,017 per 100,000 inhabitants per year, compared to 2,491 per 100,000 inhabitants per year in the rest of Greenland.
  
  
  CONCLUSIONS
  Within a short period, a rapid and dramatic change in ciprofloxacin susceptibility among GC strains isolated in Nuuk was documented and recommendation for first line treatments has changed. Continued monitoring and rethinking of primary and secondary preventive initiatives is highly recommended in this high GC incidence setting.
authors.affiliation: Department of Gynaecology and Obstetrics, Hillerød Hospital, Hillerød, Denmark; asrolskov@gmail.com.
authors.forename: Anne Skjerbæk
authors.initials: AS
authors.lastname: Rolskov
authors.affiliation: Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark.|Greenland Center for Health Research, Institute of Nursing and Health, University of Greenland, Nuuk, Greenland.
authors.forename: Karen
authors.initials: K
authors.lastname: Bjorn-Mortensen
authors.affiliation: Greenland Center for Health Research, Institute of Nursing and Health, University of Greenland, Nuuk, Greenland.|Queen Ingrid Health Care Center, Nuuk, Greenland.
authors.forename: Gert
authors.initials: G
authors.lastname: Mulvad
authors.affiliation: The Central Laboratory, Queen Ingrid Hospital, Nuuk, Greenland.
authors.forename: Peter
authors.initials: P
authors.lastname: Poulsen
authors.affiliation: Microbiology and Infection Control, Statens Serum Institut, Copenhagen, Denmark.
authors.forename: Jørgen Skov
authors.initials: JS
authors.lastname: Jensen
authors.affiliation: Greenland Center for Health Research, Institute of Nursing and Health, University of Greenland, Nuuk, Greenland; MILP@peqqik.gl.|Queen Ingrid Health Care Center, Nuuk, Greenland.
authors.forename: Michael Lynge
authors.initials: ML
authors.lastname: Pedersen
mesh_terms: D000328:Adult; D002939:Ciprofloxacin / Q000494:pharmacology*; D015331:Cohort Studies; D003081:Cold Climate; D004352:Drug Resistance, Microbial; D005260:Female; D006069:Gonorrhea / Q000175:diagnosis / Q000517:prevention & control*; D006116:Greenland / Q000453:epidemiology; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D020380:Needs Assessment; D009344:Neisseria gonorrhoeae / Q000187:drug effects* / Q000302:isolation & purification; D011322:Primary Prevention / Q000458:organization & administration*; D011634:Public Health; D012189:Retrospective Studies; D018570:Risk Assessment; D012749:Sexually Transmitted Diseases / Q000453:epidemiology / Q000517:prevention & control; D013997:Time Factors
chemical_list: D002939:Ciprofloxacin
keywords: Neisseria gonorrhoeae; antimicrobial resistance; ciprofloxacin resistance; sexually transmitted infections