A community-based outbreak of infection with penicillin-resistant Neisseria gonorrhoeae not producing penicillinase (chromosomally mediated resistance)

N Engl J Med. 1985 Sep 5;313(10):607-11. doi: 10.1056/NEJM198509053131004.


From February through November of 1983, 199 cases of penicillin-resistant Neisseria gonorrhoeae infection were identified in a localized epidemic in Durham, North Carolina. The isolates did not produce beta-lactamase but were unusually resistant to penicillin (minimum inhibitory concentration, 2.0 to 4.0 micrograms per milliliter), and 15 of 16 patients treated with 4.8 million units of penicillin G procaine plus 1.0 g of probenecid did not respond to therapy. Recognition of the outbreak was impeded by a lack of routine surveillance for resistance other than that mediated by beta-lactamase. All epidemic isolates had a single serotype, auxotype, and antibiotic-susceptibility profile. The outbreak was halted by changing the treatment for all patients and their contacts to spectinomycin, and by intensive epidemiologic case-finding efforts. The emergence of such resistant strains poses potential major public health problems and indicates a need for reassessment of current surveillance procedures.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Chromosomes, Bacterial
  • Disease Outbreaks / epidemiology*
  • Epidemiologic Methods
  • Female
  • Gonorrhea / drug therapy
  • Gonorrhea / epidemiology*
  • Humans
  • Male
  • Middle Aged
  • Neisseria gonorrhoeae / drug effects*
  • Neisseria gonorrhoeae / enzymology
  • Neisseria gonorrhoeae / genetics
  • North Carolina
  • Penicillin G Procaine / therapeutic use
  • Penicillin Resistance*
  • Penicillinase / biosynthesis
  • Probenecid / therapeutic use
  • Spectinomycin / therapeutic use
  • beta-Lactamases / analysis


  • Penicillin G Procaine
  • Spectinomycin
  • Penicillinase
  • beta-Lactamases
  • Probenecid