NEW YORK (Reuters Health) - The prevalence of fluoroquinolone-resistant Neisseria gonorrhea (QRNG) in the US is increasing rapidly, particularly among men who have sex with men (MSM), according to a report in the April 30th issue of the Morbidity and Mortality Weekly Report.

The problem has become so serious that fluoroquinolones should no longer be considered for gonorrhea in MSM in the absence of antimicrobial susceptibility testing or tests of cure, the Centers for Disease Control and Prevention advises. The same is true for patients who acquire the infection in high-incidence areas, such as California and Hawaii.

If a fluoroquinolone is considered for other patients, the clinician should first obtain travel and sexual histories, and advise return for follow-up if symptoms persist.

For the period from January to September 2003, the prevalence of QRNG in MSM was 4.9%, compared with 1.8% in 2002, excluding data from Hawaii and California, according to data from the Gonococcal Isolate Surveillance Project. The corresponding rates among heterosexual men were 0.2% and 0.4%.

In Massachusetts, QRNG accounted for 10.4% of all isolates tested for susceptibility between January and August 2003. Corresponding rates were 2.1% in 2002 and 0% in 2001. Most cases involved MSM.

In New York City, 3.4% of isolates from rectal and pharyngeal cultures obtained during the first 7 months of 2003 were resistant to fluoroquinolones, versus 0.3% in 2002.

At a press conference, the CDC's Dr. John Douglas noted that the national rate of QRNG among MSM is about 5%. For these high-risk patients, the CDC recommends intramuscular ceftriaxone. Spectinomycin IM may also be used to treat urogenital or anorectal infection.

Although the CDC has not yet changed its advice for treating gonorrhea in the general heterosexual population, their advice may change as the prevalence of QRNG increases, Dr. Douglas added.

Dr. Kenneth Mayer, from Fenway Community Health in Boston, suggested that the higher rates of QRNG among MSM may be due to an increased risk of anorectal infection, which is less likely to be symptomatic and thus less likely to be detected.

The epidemic may also be "fueled by relaxed safe sex practices, increased drug use, particularly crystal meth, and use of the Internet for meeting sex partners," Dr. Douglas added.

The two speakers also noted that surveillance efforts have primarily targeted men, but they believe the rates of QRNG in women are likely to be similar to those in heterosexual men.

Dr. Douglas also advised that clinicians follow guidelines that recommend STD screening among MSM at least twice per year. "That might curtail the epidemic," he said.

Mor Mortal Wkly Rep CDC Surveill Summ 2004;53:335-338.

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