Can Ciprofloxacin be Used for Precision Treatment of Gonorrhea in Public STD Clinics? Assessment of Ciprofloxacin Susceptibility and an Opportunity for Point-of-Care Testing

• Published in: Pathogens (Basel) Vol. 8; no. 4; p. 189
• Main Authors: Melendez, Johan H, Hsieh, Yu-Hsiang, Barnes, Mathilda, Hardick, Justin, Gilliams, Elizabeth A, Gaydos, Charlotte A
• Format: Journal Article
• Language: English
• Published: Switzerland MDPI AG 14-10-2019; MDPI
• Subjects: Age; Antibiotics; Antimicrobial agents; antimicrobial resistance; Ciprofloxacin; ciprofloxacin resistance; Demographics; Demography; Drug resistance; Epidemiology; Evaluation; Genotype & phenotype; Genotypes; Gonorrhea; HIV; Human immunodeficiency virus; Infections; Mutants; Mutation; neisseria gonorrhoeae; precision treatment; Regression analysis; Sexual behavior; Sexual orientation; Sexually transmitted diseases; STD; Surveillance; Susceptibility; Symptomology; Syphilis; United States > US; Baltimore Maryland; precision treatment; Neisseria gonorrhoeae; antimicrobial resistance; gonorrhea; ciprofloxacin resistance
• ISSN: 2076-0817; 2076-0817
• DOI: 10.3390/pathogens8040189

: Given the lack of new antimicrobials to treat
(NG) infections, reusing previously recommended antimicrobials has been proposed as a strategy to control the spread of multi-drug-resistant NG. We assessed ciprofloxacin susceptibility in a large sample set of NG isolates and identified correlates associated with ciprofloxacin-resistant NG infections.
: NG isolates collected in Baltimore, Maryland between 2014 and 2016 were evaluated by Gyrase A (
) PCR and E-test for susceptibility to ciprofloxacin. Clinical characteristics and demographics were evaluated by multivariate regression analysis to identify correlates of ciprofloxacin-resistant NG infections.
: 510 NG isolates from predominately African American (96.5%), heterosexual (85.7%), and HIV-negative (92.5%) male subjects were included in the study. The overall percentage of isolates with mutant
sequences, indicative of ciprofloxacin resistance, was 32.4%, and significantly increased from 24.7% in 2014 to 45.2% in 2016 (p < 0.001). Participants older than 35 years of age were 2.35 times more likely to have a
mutant NG infection than younger participants (p < 0.001). Race, sexual orientation, symptomology, or co-infection the HIV or syphilis were not associated with a particular NG
genotype.
: Resistance to ciprofloxacin in Baltimore is lower than other regions and indicates that in this environment, use of ciprofloxacin may be appropriate for targeted treatment provided utilization of enhanced surveillance tools. The targeted use of ciprofloxacin may be more beneficial for individuals under 35 years of age. Point-of-care tests for NG diagnosis and susceptibility testing are urgently needed to identify individuals who can be treated with this targeted approach.