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Objectives: In 1999, an increase in ciprofloxacin-resistant Neisseria gonorrhoeae isolates was identified in Hawaii, prompting initiation of investigative studies. Goals: The goal of this study was epidemioiogic evaluation of this increase. Study: The authors conducted a review of laboratory data; case-series and case-control studies based on medical record review; and a prospective case-control study based on patient interviews. Results: A total of 10.4% (21 of 201) of gonococeal isolates from Hawaii in 2000 were ciprofloxacin-resistant compared with < 1.5% per year from 1990 to 1997. From medical record review for patients diagnosed with ciprofloxacin-resistant N. gonorrhoeae infection from 1990 to 1999, 59% were Asian/Pacific Islanders and 91% were heterosexual. From review of 1998 and 1999 sexually transmitted disease (STD) clinic medical records, patients with ciprofloxacin-resistant N. gonorrhoeae were more likely to report recent foreign travel or a sex partner with recent foreign travel than patients with ciprofloxacin-susceptible N. gonorrhoeae (6 of 12 vs. 10 of 117, P Conclusions: Infections with ciprofloxacin-resistant N. gonorrhoeae are increasing and evolving in Hawaii.

Background and Objectives: Gonococcal infections caused by penicillinase-producing Neisseria gonorrhoeae (PPNG) isolates have increased in geographic distribution and prevalence. It was postulated that PPNG strains would become endemic in Honolulu and that, in turn, this city would serve as a reservoir for the introduction of PPNG strains into the continental United States. Goal of this Study: To assess the role of Honolulu as a reservoir for PPNG strains by assessing the diversity and persistence of PPNG strains between 1982 and 1991. Study Design: A total of 432 PPNG strains were characterized by auxotype/serovar (A/S) class and plasmid content, and their distribution during the 10-year period was studied. Results: Of 432 isolates, 373 (86.4%) possessed a 4.4-Mdal [beta]-lactamase plasmid; 39 (9.0%) possessed a 3.2-Mdal [beta]-lactamase plasmid; and 20 (4.6%) possessed a 3.05-Mdal [beta]-lactamase plasmid. A total of 53 A/S classes were identified. Asian, African, and Toronto PPNG strains belonged to 49 (92.5%), 15 (28.3%), and 11 (20.7%) A/S classes, respectively. Though all Toronto PPNG strains possessed a 24.5-Mdal conjugative plasmid, these plasmids could not be transferred by conjugation. Although some apparent microepidemics of PPNG strains were identified, most strins were isolated sporadically. Conclusions: A large number of different strains have been associated with PPNG infections in Honolulu, but there was no evidence that any strain persisted endemically during the study period. These observations have important implications for the design and assessment of community gonorrhea control strategies., Honolulu does not appear to be serving as a reservoir for introducing penicillin-resistant strains of gonorrhea into the continental United States. Between 1982 and 1991, 432 different strains of penicillin-resistant strains were isolated by the Hawaii Department of Health in Honolulu and the military clinics. Although it appeared that microepidemics of certain strains occurred from time to time, no evidence was found that any particular strain had become endemic. The predominance of certain strains appeared to be due to repeated reintroduction.