Eighty-nine isolates of Neisseria gonorrhoeae from 89 male
urethritis patients were studied for
beta-lactamases (
penicillinase) production, and their susceptibilities to
benzylpenicillin,
amoxicillin,
piperacillin,
clavulanic acid/
amoxicillin (
Augmentin),
cephalexin,
cefotaxime,
spectinomycin and
minocycline were determined by an
agar plate-dilution method.
Penicillinase activity was tested by a chromogenic
cephalosporin method with
nitrocefin as substrate (CefinaseTM discs, BBL, USA) and by a paper strip acidimetric method with
benzylpenicillin as substrate (
beta-Lactamase detection papers, Oxoid, UK). In addition, 60 of the 89 patients were examined for Chlamydia trachomatis, using
fluorescein-labeled
monoclonal antibodies (Direct specimen test; Micro TrakTM, Syva Co., USA).
Penicillinase-producing N. gonorrhoeae (PPNG) were found in 12 of the 89 strains (13.5%). Although all these strains of PPNG were highly resistant to
benzylpenicillin and
amoxicillin, the minimum inhibitory concentrations (MICs) of
Augmentin markedly decreased.
Piperacillin was highly active against not only non-PPNG but also PPNG strains. More than half the isolates were resistant to
cephalexin (MICs greater than or equal to 12.5 micrograms/ml) while all strains including non-PPNG and PPNG were fully sensitive to
cefotaxime (MICs less than or equal to 0.20 microgram/ml).
Spectinomycin and
minocycline had MIC ranges of 6.25 to 25 micrograms/ml and 0.01 to 3.13 micrograms/ml, respectively; the ranges for non-PPNG and PPNG strains were fairly similar. C. trachomatis was detected in 11 (18.3%) out of 60 patients examined. The increasing incidence of PPNG and coexisting chlamydial
infection should be taken into account in the treatment of gonococcal
urethritis.