Diagnosis, Therapy, and Ethical Issues in the Treatment of Multidrug Resistant Neisseria Gonorrhoeae

Gonorrhea, usually diagnosed and treated in primary care clinics, is classified as a third-category notifiable infectious diseases which requires mandatory reporting to the Taiwan Centers for Disease Control. In East Asia, as well as in Taiwan, up to 80% of gonorrheal cases are quinolone-resistant. Due to the increasing number of cases of penicillin- resistant or quinolone-resistant gonorrhea, the United States Centers for Disease Control and Prevention stopped suggesting treating gonorrhea with fluoroquinolone in 2006. In this paper, we report the cases of two young male adults with ciprofloxacin-resistant gonorrheal urethritis. One of them was initially treated with fluoroquinolone and was a treatment failure. Changing the antibiotic to ceftriaxone eventually resulted in treatment success. The other case was lost to follow-up after the diagnosis was confirmed and treatment with ceftriaxone was started. Although expedited treatment is a very important strategy for treating gonorrhea, physicians in primary care clinics in Taiwan still encounter dilemmas due to legal and ethical concerns when employing this strategy.