Epidemiologic Notes and Reports Penicillinase-Producing Neisseria
gonorrhoeae -- United States, 1986
In 1986, 16,608 cases of infection caused by
penicillinase-producing Neisseria gonorrhoeae (PPNG) were reported
to
CDC. This represented 1.8% of all reported gonorrhea and was a 90%
increase over the 8,724 cases reported in 1985. PPNG incidence has
risen fourfold since 1984. Sixty-four percent of cases in 1986
occurred in the three areas previously identified as
hyperendemic--Florida, New York City, and Los Angeles (1).
New York City experienced the greatest proportional increase of
PPNG incidence despite its policy of treating all patients
diagnosed
with gonorrhea in the public clinics with antimicrobials effective
against PPNG. In 1986, 3,986 cases were reported, compared with
the
1,567 cases reported in 1985--a 154% increase. The proportion of
total gonorrhea attributable to PPNG was 4.3%. Outbreaks have been
identified in suburban areas of New York City located on Long
Island
and in New Jersey and Westchester County.
In Florida, 5,629 PPNG cases were reported--34% of the national
total. In Dade County (Miami), Florida, the most severely affected
county in the country, reported cases of PPNG increased from 2,455
in
1985 to 2,648 in 1986--an 8% increase. In 1986, the proportion of
total gonorrhea attributable to PPNG in Dade County was 22%.
Excluding Dade County, reported cases in Florida increased from
1,710
in 1985 to 2,981 in 1986--a 74% increase. The number of counties
in
Florida reporting hyperendemic PPNG (a proportion of PPNG
3%) rose
from 16 counties in 1985 to 31 counties in 1986. These counties
contain 69% of the state's population.
In Los Angeles, the number of cases increased from 488 in 1985
to
942 in 1986--a 93% increase. Another center of PPNG activity,
probably representing secondary spread, has also been identified in
suburban Orange County.
Reported by J Hill, J Witte, MD, J Wroten, MH Wilder, MD, Acting
State
Epidemiologist, Florida Dept of Health and Rehabilitative Svcs; S
Fannin, MD, Los Angeles Health Dept; S Joseph, MD, J Miles, S
Schultz,
MD, New York City Health Dept; Div of Sexually Transmitted
Diseases,
Center for Prevention Svcs, CDC.
Editorial Note
Editorial Note: The incidence of antibiotic-resistant gonorrhea,
and
PPNG in particular, continues to increase and is spreading to
previously unaffected areas. In earlier PPNG outbreaks, travel to
PPNG endemic areas and prostitute contact were cited as risk
factors
for infection (2). While these factors may play an important role
in
the spread of PPNG disease to areas previously free of disease,
once
PPNG becomes endemic, it has the same epidemiologic characteristics
as
endemic, antibiotic-sensitive gonorrhea. PPNG patients have been
predominantly inner-city residents, members of ethnic minority
groups,
and heterosexuals. Although high-risk groups for gonorrhea have
included homosexual men, PPNG outbreaks among homosexual men are
rare. The reasons for this are not entirely clear. Recent
evidence
from a CDC study in Miami has associated PPNG infection with
inappropriate use of antibiotics (3).
Patients with inadequately treated PPNG infection are at high
risk
for complications. Women are especially at high risk for pelvic
inflammatory disease. PPNG is effectively treated with ceftriaxone
or
spectinomycin, in doses recommended in the "1985 STD Treatment
Guidelines" (4).
Once antibiotic-resistant gonorrhea becomes endemic,
eradication
is extremely difficult; it is also expensive. In these areas, all
patients with a presumptive diagnosis of gonorrhea should be
treated
with either ceftriaxone or spectinomycin. Comprehensive
recommendations for prevention, surveillance, diagnosis, and
control
of antibiotic-resistant gonorrhea have been recently developed by
CDC
in consultation with an expert advisory panel and are currently
being
reviewed by state and local health officials. These will be
published
later this spring as an MMWR supplement.
Jaffe HW, Biddle JW, Johnson SR, Wiesner PJ. Infections due to
penicillinase-producing Neisseria gonorrhoeae in the United
States: 1976-1980. J Infect Dis 1981;144:191-7.
Zenilman JM, Bonner M, Sharp K, Alexander ER.
Penicillinase-producing Neisseria gonorrhoeae (PPNG) in Miami:
etiologic roles of core group transmitters and of the illicit
use
of antibiotics (Abstract). New Orleans: 26th Interscience
Conference on Antimicrobial Agents and Chemotherapy (ICAAC),
1986.
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