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Ever since the emergence of penicillin-resistant Neisseria gonorrhoeae several decades ago, the optimal empirical treatment for gonorrhea has been a moving target. Most recently, the fluoroquinolones (ciprofloxacin, ofloxacin, and levofloxacin) have been considered the empirical therapies of choice because of their ease of use and high efficacy. However, the prevalence of quinolone-resistant N. gonorrhoeae (QRNG) has been rising steadily since 2000. This increase, first noted in the Pacific Islands (including Hawaii), has been most prominent among men who have sex with men (MSM) but is now being seen among heterosexual men as well.
Data from the CDC’s Gonococcal Isolate Surveillance Project indicate that in 2005, the prevalence of QRNG reach…