Penicillinase-Producing Neisseria Gonorrhoeae in Great Britain, 1977-81: Alarming Increase in Incidence and Recent Development of Endemic Transmission

Abstract

Since penicillinase-producing Neisseria gonorrhoeae appeared five years ago in West Africa and South-east Asia reported cases have doubled annually in Great Britain, primarily as a result of increasing importation. Importation of penicillinase-producing Neisseria gonor? rhoeae has increased exponentially because dramatic expansion of these strains in their regions of origin has led to increasing infection of male air travellers. From 1977 to 1980 infections acquired in Great Britain played only a minor part in the exponential increase. During 1981 the number of indigenous cases increased much more rapidly than imported cases, indicating that these strains have become truly endemic in Great Britain. Currently, identification of patients at high risk and initial treatment with penicillinase-resistant antibiotics offers the best hope of containing the strains. The emergence and rapid spread of penicillinase-producing Neisseria gonorrhoeae shows the international con? sequences of the abuse of antibiotics. Introduction In 1976 strains of Neisseria gonorrhoeae appeared in West Africa and South-east Asia containing plasmids which coded for penicillin-splitting enzymes ( ?-lactamases) similar to those found in Escherichia coli and Haemophilus influenzae. Their ability to spread internationally was illustrated by initial case reports from London1 and California2 and by a large epidemic in Liverpool.3 In a few years they were well established in their regions of origin and had spread worldwide.4 This continuing process threatens to render ineffective the current treatment for gonorrhoea with penicillins. Effective, alternative regimens are either more expensive or more complicated. Techniques to control the spread of these strains are urgently needed but require an understanding of how they are spreading. Great Britain is a uniquely suitable place for studying this process for three reasons. Firstly, the system of specialised, hospital-based clinics for sexually transmitted diseases with full microbiological support ensures that most cases are detected. Secondly, a voluntary system of reporting has allowed the Communicable Diseases Surveillance Centre to monitor the epidemiology of the disease since 1977. Finally, direct airline connections from both Asia and Africa have resulted in importation of the strains originating in both endemic areas. Thus, the epidemiology of these two types of penicillinase-producing Neisseria gonorrhoeae can be compared under similar conditions of importation, detection, and reporting. We have analysed the epidemiology of the disease in Great Britain based on data reported to the Communicable Diseases Surveillance Centre and have provided practical advice on their detection and treatment.