The Commonwealth of Massachusetts

Executive Office of Health and Human Services
Department of Public Health
State Laboratory Institute
305 South Street, Jamaica Plain, MA 02130

                        CLINICAL ADVISORY

MITT ROMNEY
GOVERNOR
KERRY HEALEY
LIEUTENANT GOVERNOR
RONALD PRESTON
SECRETARY
CHRISTINE C. FERGUSON
COMMISSIONER	
Date:	February 2005

To: 	Health Care Provider

From: 	Sylvie Ratelle, MD, MPH
Medical Consultant 
Tom Bertrand, MPH 
Director 
Division of STD Prevention 
Massachusetts Department of Public Health

Re: 	Increasing Number of Cases Caused by Quinolone Resistant Neisseria gonorrhoeae

Thank you for sending a morbidity card to report a case of gonorrhea. Your compliance with reporting is crucial for our surveillance efforts and is very much appreciated. We want to inform you that the number of cases of fluoroquinolone-resistant gonorrhea (FQRNG) continues to rise in Massachusetts. In 2002, a total of 10 cases were reported, all occurring in men having sex with men (MSM). In 2003, 54 cases were reported. Six of these cases occurred in the heterosexual population, with two of these cases occurring in women. Cases are not confined to urban areas. Cases are continuing to be reported in 2004 at higher pace than 2003. At the end of 2004, a total of 79 cases were reported. All were in MSM. 
We wish to reiterate our recommendation that ceftriaxone (Rocephin ® ) 250 mg IM is the preferred regimen for the treatment of uncomplicated gonococcal infections. Ceftriaxone is effective against infection at all anatomical sites, is safe to use during pregnancy and for adolescents. 
Unless antibiotic susceptibility testing performed on a positive culture excludes resistance to quinolone, we no longer recommend the use of quinolones for the presumptive treatment of gonorrhea or treatment based on a non-culture test result. The case you reported was treated with a quinolone. We recommend that a test of cure be performed at all exposed sites if a culture was not initially used to rule out resistance. 
Resistance to cephalosporins has not been reported to date. However, any time you treat someone for gonorrhea and symptoms do not resolve, be sure to order a culture on the clinical specimen so that antibiotic susceptibility testing can be performed. The STD Laboratory of the Massachusetts Department of Public Health will provide technical guidance and testing services. You can contact the STD Laboratory at 617-983-6600. 
Clinical consultation, practice guidelines and epidemiological services are available through the STD Division. Please call for any assistance at (617) 983-6940.