(S91F and D95G in GyrA and S87R in ParC). Both isolates were genotyped using N. gonorrhoeae multi-antigen sequence typing and the analysis showed that the ST225 which represented an emerging widespread multi-resistant clone that has also been associated with reduced susceptibility to ceftriaxone. We recommend continued surveillance of this pathogen to assess the efficacy of anti-gonococcal antibiotics in Brazil.Key words: Neisseria gonorrhoeae -fluroquinolone resistance -gyrA and parC -genotyping -MAST Two male patients, a 24-year-old and a 32-year-old, were treated at the sexually transmitted diseases (STD) clinic after presenting with urethral discharge and dysuria. The patients provided urethral culture swabs for Neisseria gonorrhoeae and were treated with a single oral dose of ciprofloxacin (500 mg). Because the symptoms persisted, a single dose of ceftriaxone (250 mg) intramuscular was administrated, which cured all of the symptoms. Tests later confirmed that both culture swabs were positive for N. gonorrhoeae. Both patients were human immunodeficiency virus-negative, although one of them was venereal disease research laboratory-reactive (1/4). One patient reported sexual contact with 10 casual partners in the last three months before infection, whereas the other patient reported two casual partners. It was not possible to know if patients had sexual contact in another state of Brazil or country.The gonococci were screened using several tests, including beta-lactamase BD BBL TM (BD, Franklin Lakes, NJ, USA), Serovar (Phadebact ® GC Serovar Test, Bactus AB, Huddinge, Sweden) and E-test ® (AB Biodisk, Solna, Sweden). The E-test ® was performed using a media containing a GC Medium Base (BD-Difco TM ) and 1% defined growth supplements to ciprofloxacin, ofloxacin, chloramphenicol, ceftriaxone, azithromycin, penicillin and tetracycline. Reference values for sensitivity, reduced sensitivity or resistance were set according to the Clinical and Laboratory Standards Institute + Corresponding author: wianfe@yahoo.com.br WAF, CMF and FGN contributed equally to this work. Received 24 September 2010 Accepted 6 June 2011 (CLSI 2005a) and (Van Dick et al. 1999), specifically to chloramphenicol. The ATCC 49226 strain was used as a control for antibiotic quality.The strains were not beta-lactamase producers and were classified in the WII-III serogroup with Bo, Bp, Br, Bs and Bt serotypes. The isolates showed resistance to ciprofloxacin, ofloxacin (> 32.00 µg/mL) and chloramphenicol (3 µg/mL and 2 µg/mL). One strain was classified as having chromosomally-mediated resistance to penicillin [non-PPNG, non-TRNG with penicillin, minimal inhibitory concentrations (MIC) of ≥ 2 µg/mL and tetracycline MIC of ≤ 2 µg/mL] and reduced susceptibility to tetracycline (0.75 µg/mL and 0.500 µg/mL). Both strains were susceptible to azithromycin (0.125 µg/ mL and 0.190 µg/mL). MIC values were 0.064 µg/mL and 0.032 µg/mL. The agar dilution method was used to confirm MICs of ciprofloxacin and ofloxacin at > 32.00 µg/mL. The major difference (p...

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We notify the antimicrobial tests of 83 N. gonorrhoeae isolates. The results showed that it is not viable to use penicillin and tetracycline to treat the disease. The resistance to quinolones has not precluded therapy yet. All gonococci were sensitive to ceftriaxone, and the low level of resistance to gentamicin and chloramphenicol may suggest their usage as a future therapeutic option. Keywords: Neisseria gonorrhoeae; antimicrobial; gentamicins; chloramphenicol; resistance. RESUMOReportamos os resultados de testes de suscetibilidade realizados com 83 isolados de N. gonorrhoeae. Os resultados demonstram que não é viável a utilização de penicilina e tetraciclina para o tratamento da doença. A frequência de resistência às quinolonas detectada neste corte ainda possibilita sua utilização na terapêutica. Todos os gonococos testados foram sensíveis à ceftriaxona. O reduzido nível de resistência à gentamicina e ao cloranfenicol demonstra que esses antibióticos podem ser utilizados como opção terapêutica futura.

We report new sequence types of 14 penicillinase-producing Neisseria gonorrhoeae, isolated from sexually transmitted disease clinic attendees in Manaus, Brazil. They were characterized by WI/WII/WIII groups, susceptibility testing and Multi-Antigen Sequencing Typing/Mutilocus Sequence Typing protocols. Twelve were classified as WII/III and 2 as WI and were presented resistance to penicillin and tetracycline. New alleles for por and AroE genes and novel sequence types were identified, revealing molecular characteristics not described previously. ST1590 is the common ancestor after eBURST analysis, and these findings represent an important contribution of molecular epidemiology approach in gonococci's research in Amazonas.

IntroductionThe threat of multidrug resistant Neisseria gonorrhoeae (NG) is a concern worldwide, especially in settings with emerging resistance to the extended spectrum cephalosporins. Since 2009 WHO recommendation to the countries to perform Antimicrobial Surveillance has been reinforced. Brazilian’s sexually transmitted infection guideline recommends dual therapy to treat gonococcal infection (ciprofloxacin plus azithromycin). However, regional studies performed in three Brazilian states demonstrated quinolone resistance. For these states it was recommended to replace the quinolones by third generation cephalosporin. The aim of this study was to perform a Brazilian national gonococcal antimicrobial surveillance. MethodsThe surveillance study included seven collection sites representing five geographic regions of Brazil. A total of 550 NG isolates from male urethral discharge was sent to the gonococcal national reference laboratory for analysis. The minimum inhibitory concentration (MIC) with the agar dilution method was performed for penicillin, tetracycline, ciprofloxacin, ceftriaxone, cefixime and azithromycin. ResultsThe sensitivity profile of the NG isolates was performed in 131 isolates from the Southeast, 104 from the Northeast, 100 from the North, 68 from the Center-West and 147 from the South. In addition to penicillin and tetracycline, a high level of resistance for ciprofloxacin (47% to 78% of isolates) was observed in the isolates of all the regions. All the isolates were sensitive to ceftriaxone and cefixime, although one isolate was found with elevated MIC. Regarding azithromycin sensitivity, the majority of the isolates were sensitive, but the emergence of an intermediate (5% to 15%) or resistant (4% to 10%) profile needs to be monitored. ConclusionThe national survey confirmed the high level of ciprofloxacin resistance already described worldwide. These results indicate the need to urgently change Brazilian recommendation for gonorrhoeae treatment and the importance of systematic gonococcal resistance surveillance.