We report 4 urogenital Neisseria gonorrhoeae isolates recovered from 3 patients that demonstrated resistance to penicillin, tetracycline, and ciprofloxacin and reduced susceptibility to cefixime. This report of the first 3 patients in the United States identified with this multidrug-resistant strain may portend an emerging problem for clinicians and public health officials.

We report on the first Neisseria gonorrhoeae isolate in the United States identified with high-level resistance to azithromycin. This report discusses the epidemiologic case investigation, the molecular studies of resistance-associated mutations and N. gonorrhoeae multiantigen sequence typing, and challenges posed by emerging gonococcal antimicrobial resistance.

Five false-positive gonorrhea test results from a private laboratory using a nucleic acid amplification test led to an investigation by the Hawaii State Department of Health. No unexplained increase or variation in the laboratory's positive gonorrhea test results was detected. The proportion of positive gonorrhea test results among tests performed in the population was 1.06%. The calculated positive predictive value (PPV) of the test in this setting was 60%. Documentation of sexual histories was lacking for all cases. It is imperative to obtain a sexual history for both assessing sexually transmitted disease (STD) risk and interpreting STD test results. The possibility that positive test results may be false should be considered when patients have unanticipated positive test results. Clinicians who perform STD screening tests should know the approximate prevalence of STDs in the population being screened and have a conceptual understanding of PPV and the impact of low prevalence on screening tests with imperfect specificity.

Limited studies have shown high rates of gonorrheal and chlamydial infections among incarcerated adolescents, however, this population has not been routinely targeted for sexually transmitted disease (STD) screening. This study was done to ascertain the feasibility of screening females for STDs at a juvenile detention facility in Honolulu, Hawaii, and to determine the prevalence of chlamydial and gonorrheal infections in this population. Between January 2000 and December 2001, pelvic examination-based STD screening was offered to all female detainees, on selected dates. Specimens from multiple anatomical sites were cultured for Neisseria gonorrhoeae. Endocervical swabs were tested for Chlamydia trachomatis using a DNA probe (GenProbe). One-hundred one of 204 (50%) eligible females were screened. Fourteen of 101 (13.9%) females were screen positive for chlamydial infection, while six of 101 (5.9%) were culture positive for infection with N. gonorrhoeae. Three females were co-infected with both organisms. The high STD rates justify the institution of a routine screening program for this high risk and previously underserved group.