Designing of a Multicomponent Internet-Based CME Course in the Management of Sexually Transmitted Diseases for Physicians and Midwives in Peru

Abstract

Background: To monitor quinolone resistance in Neisseria gonorrhoeae strains in Canada. Methods: N. gonorrhoeae strains were obtained from provincial public health and reference laboratories across Canada. MICs were determined by agar dilution for penicillin, spectinomycin, tetracycline, erythromycin, ceftriaxone, ciprofloxacin, cefixime, and azithromycin. Additional testing of the strain’s auxotype, and plasmid profile were also determined. Results: From 2001—2005, 28035 strains of N. gonorrhoeae were tested by laboratories across Canada. Of these, 4522 resistant strains were characterized by the National Microbiology Laboratory. During this period, an increase in ciprofloxacin resistant strains, cipR, (MIC value ≥1.0mg/L) was observed. In 2001, only 130 strains, or 2.9% of the strains tested nationally (n = 4498) were found to be resistant to ciprofloxacin. This rate increased to 6.2% (n = 4018) in 2004, and by 2005 the number of cipR strains increased to 570 accounting for 15.8% (n = 3619) of the year’s total. From the 1159 cipR strains characterized during this time frame, the auxotype/plasmid profiles of NR/2.6 Mdal and P/2.6 Mdal were the most common, 33.7% and 31.8% respectively. Of the 1096 cipR strains characterized where the gender and age were known, 86.4% of the strains were from males. The majority of patient ages were between 20—39 for both genders, 65.0% for males and 64.4% for females. Conclusion: Ciprofloxacin resistance in N. gonorrhoeae within Canada has increased to a level where ciprofloxacin is no longer an option for treatment. The treatments now available are spectinomycin or the third generation cephalosporins, such as ceftriaxone and cefixime. A sentinel surveillance system is being considered to collect representative strains as more laboratories are shifting to nucleic acid based diagnosis.