Correlates of gonococcal infection and of antimicrobial-resistant Neisseria gonorrhoeae among female sex workers, Republic of the Philippines, 1996-1997.

From 1994 to 1997, the proportion of Neisseria gonorrhoeae highly resistant to ciprofloxacin (MIC >/=4 microg/mL) increased substantially among female sex workers (FSWs) in the Philippines. Among 1499 Filipina FSWs, we evaluated factors associated with gonococcal infection and with gonococcal antimicrobial resistance. By multivariate analysis, gonococcal infection was associated with sex with a new client, self-prescribed prophylactic antimicrobial use, work in a brothel, and inconsistent condom use and was negatively associated with registration status and vaginal hygiene practices. Factors associated with ciprofloxacin-resistant gonococci included: marital status, living alone, duration of sex work, and clinic site. Further, gonococci highly resistant to ciprofloxacin were isolated from 10 (11.5%) of 87 FSWs reporting self-prescribed antimicrobial use versus 44 (3.4%) of 1295 reporting no antimicrobial use (P<.001). Self-prescribed prophylactic antimicrobial use and inconsistent condom use could be important factors in the continued emergence of gonococcal antimicrobial resistance in the Philippines.

Molecular epidemiology, in 1994, of Neisseria gonorrhoeae in Manila and Cebu City, Republic of the Philippines.

BACKGROUND AND OBJECTIVES: Failure of gonococcal infections to respond to 500 mg of ciprofloxacin or 400 mg of ofloxacin has been reported from Australia, the United Kingdom, and the United States. Recently, high rates of decreased susceptibility to the fluoroquinolones have been detected in penicillinase-producing Neisseria gonorrhoeae in the Republic of the Philippines. GOALS: To assess the diversity of antimicrobial-resistant gonococcal strains isolated from female sex workers in Manila and Cebu City in the Republic of the Philippines in 1994. STUDY DESIGN: Isolates of N. gonorrhoeae isolated from 92 female sex workers in Manila (n = 28) and Cebu City (n = 64), respectively, were characterized by plasmid profile, auxotype/serovar class, and antimicrobial susceptibility profile. RESULTS: Plasmid-mediated resistance to penicillin or tetracycline was identified in 79.3% (73/92) of the isolates: penicillinase-producing N. gonorrhoeae (65/92; 70.7%), tetracycline-resistant N. gonorrhoeae (6/92; 6.5%), and penicillinase-producing/tetracycline-resistant N. gonorrhoeae (1/92; 1.1%). A beta-lactamase plasmid of 3.9 megadaltons was discovered. Of 54.3% (50/92) of strains resistant to nalidixic acid, 84% (42/50) of strains had minimum inhibitory concentrations of > or = 0.125 microgram/ml ciprofloxacin; penicillinase-producing N. gonorrhoeae (possessing the 3.05-, 3.2-, 3.9-, and 4.4-megadalton beta-lactamase plasmids, respectively) accounted for 68% (34/50) of these strains. CONCLUSIONS: In the Republic of the Philippines, gonococcal isolates resistant to penicillin or tetracycline accounted for 85.9% (79/92) of the isolates examined and included strains exhibiting resistance to fluoroquinolones. All gonococcal infections should be treated with antimicrobial therapies known to be active against all gonococcal strains to reduce the spread of strains exhibiting decreased susceptibilities to fluoroquinolones.

PIP: During July-October 1994 in the Philippines, Neisseria gonorrhoeae were isolated from 92 female sex workers in Manila and Cebu City. The purpose was to characterize the gonococcal strains by plasmid content, auxotype, serovar, and antimicrobial susceptibilities in order to examine the diversity of antimicrobial-resistant N gonorrhoeae strains in these sex workers. Penicillinase-producing N gonorrhoeae (PPNG) comprised 70.7% of the isolates. Strains with the 3.2-megadalton (Mda) beta-lactamase plasmid were more common in Cebu City than in Manila (57.8% vs. 28.6%; p = 0.02). They had significantly lower minimum inhibitory concentrations (MICs) to penicillin, tetracycline, ceftriaxone, ciprofloxacin, and erythromycin than did strains with 3.05-, 3.9-, or 4.4-Mda plasmid (p 0.01). One PPNG strain had a previously undescribed 3.9-Mda beta-lactamase plasmid. It also had a 24.5-Mda conjugative plasmid. Only 15.2% of all 92 isolates were susceptible to both penicillin and tetracycline. Tetracycline-resistant N gonorrhoeae (TRNG) comprised 6.5% of the isolates. 1.1% of isolates were resistant to both penicillin and tetracycline. 54.3% of all strains were resistant to nalidixic acid (fluoroquinolone), 84% of which had MICs of at least 0.125 mcg/ml ciprofloxacin. 68% of the nalidixic acid-resistant strains had 4.4 Mda beta-lactamase plasmids. 85.9% of all gonococcal isolates exhibited resistance to penicillin or tetracycline. They also included strains exhibiting resistance to fluoroquninolones. These findings reveal the need for periodic surveillance for resistance in N gonorrhoeae to the antimicrobial agents used for primary gonorrhea therapy in order to improve the treatments of choice.