Background 

Until 1992, almost all strains of Neisseria gonorrhoeae that had been tested in the United States were susceptible to fluoroquinolones, including ciprofloxacin.

However, among men with urethral gonococcal infections who attended one sexually transmitted disease clinic in Cleveland, Ohio, the prevalence of gonococci with decreased susceptibility to ciprofloxacin increased from 2% in 1991 to 16% in 1994.

Objective 

To describe the emergence of and risk factors for gonococcal urethritis caused by gonococci with decreased susceptibility to ciprofloxacin.

Resistance to ciprofloxacin was considered to be decreased if the mean inhibitory concentration was at least 0.12 mug/mL and was less than or equal to 0.25 mug/mL ; this definition did not equate with the definition of clinical resistance.

Design 

Case-control study.

Setting 

An urban sexually transmitted disease clinic.

Participants 

51 case-patients and 106 controls.

Measurements 

Pulsed-field gel electrophoresis was used to identify individual genotypes of ciprofloxacin-resistant and ciprofloxacin-susceptible isolates.

Results 

55 of the 746 isolates of N. gonorrhoeae that were tested (7.4%) had decreased susceptibility to ciprofloxacin, and the prevalence of N. gonorrhoeae with decreased susceptibility significantly increased during the study period.

Case-patients were significantly less likely to have gram-negative diplococci seen on microscopic examination of urethral discharge (P ¾ 0. (...)