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Can Ciprofloxacin be Used for Precision Treatment of Gonorrhea in Public STD Clinics? Assessment of Ciprofloxacin Susceptibility and an Opportunity for Point-of-Care Testing

1
Division of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA
2
Department of Emergency Medicine, Johns Hopkins University, Baltimore, MD 21205, USA
3
Johns Hopkins School of Medicine, Baltimore, MD 21205, USA
*
Author to whom correspondence should be addressed.
Pathogens 2019, 8(4), 189; https://doi.org/10.3390/pathogens8040189
Received: 18 September 2019 / Revised: 1 October 2019 / Accepted: 4 October 2019 / Published: 14 October 2019
(This article belongs to the Special Issue Neisseria gonorrhoeae Infections)
Background: Given the lack of new antimicrobials to treat Neisseria gonorrhoeae (NG) infections, reusing previously recommended antimicrobials has been proposed as a strategy to control the spread of multi-drug-resistant NG. We assessed ciprofloxacin susceptibility in a large sample set of NG isolates and identified correlates associated with ciprofloxacin-resistant NG infections. Methods: NG isolates collected in Baltimore, Maryland between 2014 and 2016 were evaluated by Gyrase A (gyrA) PCR and E-test for susceptibility to ciprofloxacin. Clinical characteristics and demographics were evaluated by multivariate regression analysis to identify correlates of ciprofloxacin-resistant NG infections. Results: 510 NG isolates from predominately African American (96.5%), heterosexual (85.7%), and HIV-negative (92.5%) male subjects were included in the study. The overall percentage of isolates with mutant gyrA sequences, indicative of ciprofloxacin resistance, was 32.4%, and significantly increased from 24.7% in 2014 to 45.2% in 2016 (p < 0.001). Participants older than 35 years of age were 2.35 times more likely to have a gyrA mutant NG infection than younger participants (p < 0.001). Race, sexual orientation, symptomology, or co-infection the HIV or syphilis were not associated with a particular NG gyrA genotype. Conclusions: Resistance to ciprofloxacin in Baltimore is lower than other regions and indicates that in this environment, use of ciprofloxacin may be appropriate for targeted treatment provided utilization of enhanced surveillance tools. The targeted use of ciprofloxacin may be more beneficial for individuals under 35 years of age. Point-of-care tests for NG diagnosis and susceptibility testing are urgently needed to identify individuals who can be treated with this targeted approach. View Full-Text
Keywords: Neisseria gonorrhoeae; gonorrhea; antimicrobial resistance; ciprofloxacin resistance; precision treatment Neisseria gonorrhoeae; gonorrhea; antimicrobial resistance; ciprofloxacin resistance; precision treatment
MDPI and ACS Style

Melendez, J.H.; Hsieh, Y.-H.; Barnes, M.; Hardick, J.; Gilliams, E.A.; Gaydos, C.A. Can Ciprofloxacin be Used for Precision Treatment of Gonorrhea in Public STD Clinics? Assessment of Ciprofloxacin Susceptibility and an Opportunity for Point-of-Care Testing. Pathogens 2019, 8, 189.

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