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Background: Effective treatment of gonorrhea is essential to disease control efforts; however, the ability of gonorrhea to develop resistance to successive waves of antimicrobial agents has hindered public health strategies. We examined surveillance data to ascertain local trends in antimicrobial resistance among Neisseria gonorrhoeae isolates.
Methods: We analyzed data from the Gonococcal Isolate Surveillance Project (GISP) for male patients attending two sexually transmitted infection clinics in Chicago between 2008 and 2012. We assessed trends in susceptibility to cephalosporins among gonococcal isolates. We performed univariate analyses to identify risk factors associated with cephalosporin-decreased susceptibility.
Results: The prevalence of isolates with decreased susceptibility to cefpodoxime increased between 2008 and 2012 from 0.4% to 2.9%, respectively. The prevalence of isolates with decreased susceptibility to cefixime increased between 2008 and 2010 from 0.4% to 0.8%, and then declined in 2011 and 2012 to 0.0% and 0.03% respectively, concomitant with the change in CDC treatment guidelines in 2010 that no longer recommended the routine use of cefixime, and instead recommended combination therapy with ceftriaxone 250 mg plus azithromycin or doxycycline. No isolates with decreased susceptibility to ceftriaxone were identified from 2008 to 2012. Univariate analyses revealed isolates with decreased susceptibility to cefpodoxime were associated with infection among men who have sex with men (crude odds ratio 3.9, 95% CI 1.3-11.6; p<0.01).
Conclusions: Gonococcal cephalosporin resistance might emerge more rapidly among men who have sex with men in Chicago. Ongoing enhanced surveillance is needed to determine the frequency of cephalosporin-decreased susceptibility and -resistant N. gonorrhoeae. Alternative oral antibiotics for the treatment of gonorrhea are urgently needed.