Gonorrhea

During a 10-year period from 1976 to 1985, N. gonorrhoeae demonstrated remarkable genetic resiliency in developing clinically important antimicrobial resistance through a variety of chromosomal mutations and by acquiring either entire plasmids or resistance determinants on plasmids from other species. Gonococcal resistance is widespread, and few communities will be spared all types. None of the newer diagnostic technologies has provided any performance or cost advantages over traditional Gram-stained smears and cultures. The two most important components of a control program are (1) the National Gonococcal Isolate Surveillance project and (2) treatment with ceftriaxone, 125 or 250 mg intramuscularly, which is active against all known types of resistance and will cure all forms of uncomplicated gonorrhea, including the more difficult-to-treat infections of the pharynx and anorectum. Fear of AIDS has had a powerful motivating effect on sexual behavior, and in the United States has been associated with an overall reduction in incidence of gonorrhea in homosexual men of over 95%. After peaking in 1985, incidence of gonorrhea in white heterosexual men and women has declined as well. A diagnosis of gonorrhea in 1990 implies recent high-risk behavior for acquiring HIV infection. The gonorrhea epidemic in the United States is rapidly contracting down around poor urban minorities; although this is not good, at least it tells us where to target our resources.