Increases in fluoroquinolone-resistant Neisseria Gonorrhoeae among men who have sex with men - United States, 2003, and revised recommendations for gonorrhea treatment, 2004. MMWR 2004, 53(16):335-38.
Based on monitoring at 30 sexually transmitted disease clinics in the United States, the national prevalence of fluoroquinolone-resistant Neisseria gonorrhoeae is almost 5%. As a result of these increased rates, particularly among men who have sex with men (MSM), the Centers for Disease Control and Prevention (CDC) advises against the use of fluoroquinolones as first-line treatment for gonorrhea in MSM. Because the prevalence of quinolone-resistant N. gonorrhoeae among heterosexuals remains low (0.4%), a national change in treatment for this group has not been recommended. However, resistance is increasing and clinicians need to be aware of local recommendations, which may differ from national guidelines. Cefixime, the only oral therapy other than fluoroquinolones that the CDC advises, is not currently available in the United States. Therefore, patients with gonorrhea who are MSM or who provide a history suggesting acquisition of infection in an area with a high rate of fluoroquinolone resistance (e.g. Asia, California, the Pacific Islands including Hawaii, and England or Wales) should receive intramuscular ceftriaxone 125 mg. In cases of persistent gonococcal infection after treatment with fluoroquinolones, antimicrobial susceptibility testing should be performed. Clinicians should report treatment failures or resistant gonococcal isolates to the CDC through their local health departments.