A decade of PPNG in Singapore
Chan, R.K.; Thirumoorthy, T.
Annals of the Academy of Medicine Singapore 16(4): 639-644
1987
ISSN/ISBN: 0304-4602 PMID: 2965543 Document Number: 298960
The prevalence of penicillinase-producing Neisseria gonorrhoea (PPNG) has increased progressively in Singapore since its emergence in 1976, while non-PPNG cases have shown a steady decline since 1979. The proportion of total gonorrhea cases represented by PPNG has remained at about 35% since 1982, with female prostitutes accounting for 2.3 of PPNG cases. 80% of males in Singapore infected with PPNG in 1984 were 15-29 years of age and over 70% were single. In a 1978 survey, 72% of male patients with PPNG treated at the Middle Road and Singapore General Hospitals acknowledged sexual contact with professional prostitutes. Clinical manifestations of PPNG have included gonococcal ophthalmia neonatorum, epididymo-orchitis, pelvic inflammatory disease, parostitis, and disseminated gonococcal infection. The emergence of PPNG has necessitated a search for antibiotics both resistant to beta-lactamase and effective against chromosomally mediated resistant Neisseria gonorrhoea. Following unacceptably high failure rates with kanamycin and spectinomycin, second and third generation cephalosporins have become the mainstay of treatment. A single 500 mg intramuscular dose of cefotaxime combined with 1 gm of oral probenecid cures 93% of PPNG infections in men and 100% of those in women. Although this treatment regimen has maintained the prevalence of PPNG cases at 35%, the medical costs of treatment have increased 100-200% over those for non-PPNG. Future control of PPNG in Singapore will be based on a multifaced strategy of effective drug treatment, control of infections in prostitutes and efforts to curb their practice of self-medication, increased laboratory bacteriological surveillance, and contact tracing.