NEW YORK (Reuters Health) - Ciprofloxacin resistance in Neisseria gonorrhoeae isolates from Hawaii has risen from less than 1.5% before 1997 to 10.4% in 2000, according to a report in the December issue of Sexually Transmitted Diseases.

Fluoroquinolones like ciprofloxacin have been first-line treatment for gonococcal infections since 1993, the authors point out, but fluoroquinolone-resistant N. gonorrhoeae were first identified in Hawaii as early as 1991.

An increase in such pathogens in 1999 prompted Dr. Christopher J. Iverson and colleagues from the Centers for Disease Control and Prevention, Atlanta, and the Hawaii Department of Health, Honolulu, Hawaii to initiate an investigation.

Overall, after declining steadily during the early 1990s, the number of gonorrhea cases reported to the Hawaii STD Program remained constant at approximately 500 cases per year from 1996 to 2000.

The percentage of isolates that were resistant to ciprofloxacin increased from less than 1.5% in 1996 to 6.3% in 1998 and 10.4% by 2000, the authors report. At the same time, the percentage of isolates that showed intermediate resistance to ciprofloxacin increased slowly until 1998, and then declined.

Most of the resistant isolates were also resistant to penicillin, and 28% were also resistant to tetracycline. Nevertheless, all isolates tested were susceptible to ceftriaxone, cefixime, azithromycin, and spectinomycin.

Ciprofloxacin-resistant isolates were more common among patients who had recently traveled in Asia or had a sex partner who had done so.

Based on these findings, the authors conclude that antimicrobials such as ciprofloxacin, ofloxacin, and levofloxacin "are no longer recommended treatment for gonorrhea infections acquired in Hawaii, Asia, or the Pacific Islands or for those" with "a sex partner who recently traveled to these locations."

Sex Transm Dis 2004;31:702-708

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