Ceftriaxone-Resistant Neisseria gonorrhoeae , Japan

Abstract

To the Editor: Spread of multidrug-resistant Neisseria gonorrhoeae is a major public health concern.Effective antimicrobial therapy is a key element in gonorrhea control.However, N. gonorrhoeae has developed resistance to multiple classes of antimicrobial drugs, including β-lactams, tetracyclines, and fl uoroquinolones (1-3).Even an extended-spectrum oral cephalosporin-resistant, cefi ximeresistant N. gonorrhoeae has emerged, and cefi xime has now been withdrawn from use in Japan.Best practice treatment is limited to injectable extended-spectrum cephalosporins, such as ceftriaxone and spectinomycin.The emergence of ceftriaxone-resistant N. gonorrhoeae threatens effective disease control.We identifi ed a novel ceftriaxone-resistant N. gonorrhoeae isolated from a 31-year-old female commercial sex worker; MIC of ceftriaxone for this isolate was high (2 μg/mL).The woman visited a clinic in Kyoto for a routine examination for sexually transmitted infections in January 2009.Although she had no obvious symptoms or signs, a throat sample collected on her fi rst visit yielded a positive result for N. gonorrhoeae by the strand displacement amplifi cation test (ProbeTec ET, Becton Dickinson, Franklin Lakes, NJ, USA), but a vaginal sample taken at the same time was negative.After 2 weeks, another throat sample was positive for N. gonorrhoeae when cultured on Thayer-Martin medium, and the patient subsequently received 1 g ceftriaxone intravenously.Her pharyngeal sample was also N. gonorrhoeae positive by strand displacement amplifi cation test on the third visit 2 weeks later, and further ceftriaxone treatment was prescribed.However, a culture for test of cure was not conducted because reinfection was