Antimicrobial susceptibility and types of Neisseria gonorrhoeae in Greece. Data for the period 1990 to 1993.

Background: Surveillance of the rapidly changing patterns of antimicrobial resistance of Neisseria gonorrhoeae is imperative for monitoring gonococcal infection. Goal: To describe the types and the antimicrobial susceptibility profile of a representative sample of gonococci isolated in Greece between 1990 and 1993. Study Design: The antimicrobial susceptibilities, serovar/auxotypes classes, and plasmid contents of 263 consecutive isolates of N. gonorrhoeae, recovered from cases of male gonococcal urethritis, were determined. Results: Penicillinase-producing N. gonorrhoeae (PPNG) were isolated at a rate 6.1% and were mostly from imported cases of infection. Six (2.3%) of the isolates (one PPNG and five non-PPNG) were highly resistant to tetracycline, and one PPNG strain was resistant to norfloxacin and ciprofloxacin. Strains with chromosomal resistance to penicillin, tetracycline, erythromycin, and chloramphenicol accounted for 18.5%, 12.5%, 19%, and 16% of the isolates, respectively; much higher proportions of strains were intermediately susceptible to these ,antibiotics. Spectinomycin and cefotaxime were active against all gonococci studied. A shift to IB serovars and to sporadic types of strains was noted from previous years among the non-PPNG isolates. This is compatible with the marked increase in the rate of imported cases of infection caused by non-PPNG strains. Conclusions: The emergence of high-level resistance to tetracycline and resistance to fluoroquinolones was ascertained. At the present, however, the main problem with gonococcal resistance in Greece seems to ensue from the increasing rates of chromosomally resistant strains. Moreover, the increasing frequency of imported gonococci underlines the necessity for continuous epidemiologic surveillance.