To:                             Health Alert Network
From:                   Robert Zimmerman, MPH
    Secretary of Health
Date:                           July 26, 2002
Subject:                        Second East Coast Ciprofloxacin-Resistant
Gonorrhea Case
Identified in Philadelphia Counties Affected:   Statewide Distribution

This transmission is a "Health Advisory", which provides important
information for a specific incident or situation; may not require
immediate action.

HOSPITALS: PLEASE SHARE THIS WITH ALL MEDICAL, PEDIATRIC, INFECTION
CONTROL, NURSING, AND LABORATORY STAFF IN YOUR HOSPITAL

LOCAL HEALTH JURISDICTIONS PLEASE DISTRIBUTE TO ALL PRIMARY CARE
PHYSICIANS IN THE FOLLOWING COUNTIES:  All

The Philadelphia Department of Public Health (PDPH) has reported a
ciprofloxacin-resistant gonococcal isolate from a gay male with urethral
symptoms seeking STD services at their main STD clinic in February 2002.
The testing was performed through the Centers for Disease Control and
Prevention (CDC) Gonococcal Isolate Surveillance Project (GISP); it was
reported to PDPH on July 1, 2002.  This is the second reported case of
ciprofloxacin-resistant gonorrhea reported on the East Coast, with the
first being reported in Maine earlier this year.  The CDC has noted that
there has been a considerable increase in this resistant strain of
gonorrhea on the West Coast focused mainly in California.

In addition to Philadelphia, the Allegheny County Health Department
continues to perform antibiotic susceptibility testing on positive
gonorrhea isolates from patients with persistent infection. These
susceptibility tests check for resistance to several antibiotics,
including:  Penicillin, Ceftriaxone, Tetracycline, Ciprofloxacin, and
Spectinomycin. In CY 2001, there were a total of 51 cases of Penicillin
and/or Tetracycline resistant gonorrhea identified in Allegheny County, an
increase of 25% (13 cases) over the 38 resistant cases identified in 2000.
 (N.B. Penicillin and Tetracycline are not recommended therapies for
gonococcal infections) Of all resistant cases identified in 2000 and 2001,
none were determined to be resistant to Ciprofloxacin, Ceftriaxone or
Spectinomycin. As a precaution, the STD Program also stocks two
antibiotics, Ceftriaxone (Rocephin) and Cefixime (Suprax) as treatment
alternatives to the fluoroquinolones (Ciprofloxacin/Ofloxacin).

Many STD clinics routinely use non-culture methods for the detection of
gonorrhea. However, each STD clinic has a supply of culture plates to
evaluate throat and rectal specimens, and to evaluate possible treatment
failures.  STD service providers statewide are strongly encouraged to ask
clients about their sexual practices and offer throat and rectal cultures
when needed.  In addition, patients should be asked about any sexual
contact with persons who have traveled to or reside in Hawaii, the West
Coast or outside the United States.  Risk of resistant gonorrhea
infections acquired from these areas is high; therefore, these patients
should be treated with Cefixime or Ceftriaxone to ensure adequate therapy.

For patients with persistent symptoms after therapy with a fluoroquinolone
antibiotic, please call one of the numbers below for further information
and assistance.

The Pennsylvania STD Program is currently working to identify sites to
perform antibiotic resistance testing in the Department of Health's
Northeast and Southcentral Health Districts.

Additional Information

Physicians needing additional information are asked to call the following
numbers:

The Pennsylvania Department of Health
Bureau of Communicable Disease
Division of TB/STD
STD Program
(717) 787-3981
8:00 A.M. - 5:00 P.M.

The Philadelphia Department of Public Health
Division of Disease Control
STD Control Program
(215) 685-6737
8:30 A.M. -5:00 P.M.