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Spectinomycin is recommended as an alternative antimicrobial in CDC treatment guidelines of uncomplicated gonococcal infection.1 There are reports available on spectinomycin resistant Neisseria gonorrhoeae isolates from China, Philippines, and Sri Lanka but no resistance has been reported from India and other South East Asia Region countries such as Bangladesh, Thailand, and Indonesia.2 To our knowledge, this is the first report of spectinomycin resistant N gonorrhoeae from India.
A 21 year old female patient with a history of vaginal discharge for the past month, attended the gynaecology outpatient department of Safdarjung Hospital in August 2002. On speculum examination purulent cervical discharge was noticed. Investigations were carried out for demonstration and isolation of N gonorrhoeae, Candida albicans, Trichomonas vaginalis, and pyogenic organisms using standard techniques. Endocervical currettings were collected for Chlamydia trachomatis antigen detection. Blood specimen was taken for VDRL, TPHA, HIV (after pretest counselling), and HBs Ag. All the tests proved negative, but on microscopy of the endocervical smear, Gram negative intracellular diplococci were observed. N gonorrhoeae was isolated on chocolate agar and saponin lysed blood agar with VCNT inhibitors. Standard methods3 were utilised for confirmation of the isolate. Antimicrobial susceptibility testing towards penicillin, tetracycline, ciprofloxacin, ceftriaxone, and spectinomycin was carried out by the Australian Gonococcal Surveillance Programme method based on the calibrated dichotomous sensitivity technique.3 The isolate was observed to be sensitive to penicillin, tetracycline, ciprofloxacin, and ceftriaxone but resistant to spectinomycin. Minimum inhibitory concentration by agar dilution technique was observed to be 128 µg/ml (cut-off value for spectinomycin resistance ⩾128 µg/ml).
The patient was treated with ciprofloxacin 500 mg, single dose. Test of cure was performed after 2 weeks.
The regional STD Teaching, Training and Research Centre has been monitoring antimicrobial susceptibility of N gonorrhoeae for penicillin, tetracycline, ciprofloxacin, and ceftriaxone since 1995 and has been acting as the WHO regional reference laboratory for the Gonococcal Antimicrobial Susceptibility Programme (GASP) in South East Asia Region since 1999. Antimicrobial susceptibility testing for spectionomycin started in 2000 under GASP.
From 2000 to 2003 antimicrobial susceptibility testing has been carried out in 449 consecutive isolates of N gonorrhoeae. Out of 449 isolates, 413 were from male patients with acute gonococcal urethritis and 36 from females with cervicitis. All the isolates were found to be sensitive to spectinomycin except this isolate.
This centre is also collecting and analysing data from focal point laboratories in India under GASP (Chennai, Delhi, Hyderabad, Kolkata) and 100% isolates were reported to be sensitive to spectinomycin in India.
Detection of a spectinomycin resistant isolate is a cause for concern as there are reports of resistance from other countries—as high as 11.1% from China.4 Spectinomycin is the best alternative for patients allergic to cephalosporins.
The authors acknowledge WHO SEAR, New Delhi for financial assistance and Dr J Tapsall, Neisseria Reference Laboratory, Prince of Wales Hospital, Sydney, Australia for supplying antibiotic discs and WHO reference strains. The authors thank Mrs Leelamma Peter for technical assistance.