Continuous Surveillance of Antibiotic ResistantNeisseria Gonorrhoeae: A Tool to Forewarn Emerging Trends in Resistance

A DE CREASE IN THE IN CI DENCE OF GON OR RHOEA cases has been re ported in the past 20 years by sev eral west ern coun tries (1-4). Sta tis tics in Can ada show this de cline start ing in the early 1980s, from a peak of 56,336 cases re ported in 1981 to an es ti mated 4500 cases in 1994, a 92% de crease in the to tal number of cases over a 13year pe riod. Al though the in ci dence of gon or rhoea cases is drop ping, there is a con stant in crease in the number of re sis tant iso lates that par al lels the in tro duc tion of new an ti bi ot ics. The abil ity of the gono coc cus to de velop re sis tance to an ti bi ot ics has been shown re peat edly over the years. As early as 1976, chro mo somally me di ated re sis tance to peni cil lin and later mul ti ple re sis tance to other an ti bi ot ics were re ported along with plas mid me di ated re sis tance to peni cil lin (1,5-7). As a re sult, tet ra cy cline was cho sen as the al ter na tive treat ment for penicillinaseproducing Neis se ria gon or rhoeae (PPNG) un til tet ra cy cline re sis tant strains were char ac ter ized in the United States in 1985 and later re ported world wide (8-11). Cur rently, thirdgeneration cephalosporins and qui nolones are the most ef fec tive anti microbials against gon or rhoea (12,13). The de tec tion of these sus cep ti bil ity changes and the ac cu rate pre dic tion of up com ing re sis tance trends are pos si ble only if a con tinu ous sur veil lance pro gram is in ef fect.