Abstract
Since 1994, the incidence of gonorrhoea in Østfold county, Norway, has remained within the range of 1-8 cases per year, with 40% of cases being imported from abroad. On 20 January 2008, a general practitioner in the county diagnosed two seemingly unrelated domestic cases of gonorrhoea in three days and started contact tracing. A case was defined as a person with clinical symptoms of gonorrhoea who was a part of the sexual network. Available isolates from the samples taken were tested for resistance. Among 13 contacts identified in the sexual network, eight were classified as cases on the basis of symptoms, four of whom had laboratory-confirmed gonorrhoea. The index case acquired the infection abroad. The three isolated strains were resistant to ciprofloxacin, but sensitive to ceftriaxone which was used for treatment. In the outbreak described, most cases were diagnosed only after contact tracing although they had had symptoms. A quinolone-resistant strain was imported from abroad and introduced into the population. The Norwegian national treatment guidelines, which still recommend quinolones for empirical treatment, should be updated.
Highlights
Gonorrhoea is a sexually transmitted disease with a high transmission rate and a short incubation period of two to seven days [1]
Culturing of Neisseria gonorrhoeae has lower sensitivity than some newer methods [3,4], but obtaining a culture is important for determining antimicrobial resistance [2]
All available sexual contacts were tested for gonorrhoea, hepatitis B virus (HBV), hepatitis C virus (HCV), HIV, chlamydia and syphilis
Summary
Background Gonorrhoea is a sexually transmitted disease with a high transmission rate and a short incubation period of two to seven days [1]. The risk of male to female transmission is assumed to be as high as 50-70% per sexual intercourse and the risk of female to male transmission is estimated to be 20-30% [2]. The disease most frequently manifests as purulent discharge and dysuria, but up to 50% of women and 2-5% of heterosexual men can be asymptomatic. Rectal and pharyngeal infections are frequently asymptomatic. Laboratories and clinicians are obliged to report data on gonorrhoea patients anonymously to the Norwegian surveillance system of communicable diseases (Meldingssystem for smittsomme sykdommer – MSIS) (5). Since 1993, over 90% of the samples from the patients reported to MSIS have been cultured
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