A COMMUNITY-BASED OUTBREAK OF INFECTION WITH PENICILLIN-RESISTANT NEISSERIA-GONORRHOEAE NOT PRODUCING PENICILLINASE (CHROMOSOMALLY MEDIATED RESISTANCE)

From Feb., through Nov. 1983, 199 cases of penicillin-resistant N. gonorrhoeae infection were identified in a localized epidemic in Durham, North Carolina [USA]. The isolates did not produce .beta.-lactamase but were unusually resistant to penicillin (minimum inhibitory concentration, 2.0-4.0 .mu.g/ml), and 15 of 16 patients treated with 4.8 million units of penicillin G procaine plus 1.0 g of probenecid did not respond to therapy. Recognition of the outbreak was impeded by a lack of routine surveillance for resistance other than that mediated by .beta.-lactamase. All epidemic isolates had a single serotype, auxotype and antibiotic-susceptibility profile. The outbreak was halted by changing the treatment for all patients and their contracts to spectinomycin, and by intensive epidemiologic case-finding efforts. The emergence of such resistant strains poses potential major public health problems and indicates a need for reassessment of current surveillance procedures.