Phenotypic and genotypic properties of isolates in Norway in 2009: antimicrobial resistance warrants an immediate change in national management guidelines

Despite rapidly diminishing treatment options for and high levels of ciprofloxacin resistance worldwide, Norwegian guidelines still recommend ciprofloxacin as empirical treatment for gonorrhea. The present study aimed to characterize phenotypical and genotypical properties of isolates in Norway in 2009. All viable isolates ( = 114) from six university hospitals in Norway (2009) were collected, representing 42% of all notified gonorrhea cases. Epidemiological data were collected from the Norwegian Surveillance System for Communicable Diseases and linked to phenotypical and genotypical characteristics for each isolate. Resistance levels to the antimicrobials examined were: ciprofloxacin 78%, azithromycin 11%, cefixime 3.5%, ceftriaxone 1.8%, and spectinomycin 0%. The minimum inhibitory concentrations of gentamicin varied from 1.5 to 8 mg/L. Forty-one (36%) of the isolates were beta-lactamase-producing, 17 displayed mosaic alleles, and 72 different multiantigen sequence types (ST; 37 novel) were identified. The most common ST was ST1407 ( = 11), containing mosaic allele. Four of these isolates displayed intermediate susceptibility/resistance to cefixime. The strains circulating in Norway were highly diverse. The level of ciprofloxacin resistance was high and the Norwegian management guidelines should promptly exclude ciprofloxacin as an empirical treatment option for gonorrhea.