changing treatment regimes when resistance to a particular agent reaches 5%. 4 Ciprofloxacin treatment of intermediately resistant cases has a failure rate of 8%, which rises to 60% in fully resistant cases. 6 The data show the importance of ongoing surveillance of susceptibility trends, in particular to modify treatment guidelines. Paradoxically, as resistance rates and the need for adequate surveillance rise, there has been a recent steep decline in reported cases of sexually transmitted infections (STIs) in Malaysia. 2 This has been attributed to more patients self-treating or seeking confidential treatment from private doctors, and the introduction of the modified syndromic approach in 1999. 2 These factors result in fewer clinical samples being obtained, and thus fewer isolates of N. gonorrhoeae on which to base the surveillance. This is reflected in the small absolute numbers of N. gonorrhoeae seen in our study, which may also be from selected cases not responding to treatment, and thus unrepresentative of overall susceptibility patterns.With rising resistance to previously useful agents, and the recent appearance of strains with reduced ceftriaxone susceptibility, the treatment of N. gonorrhoeae in this region is becoming increasingly difficult. 4 Furthermore, increases in our population's mobility and the number of immigrants have resulted in greater exposure to multiresistant N. gonorrhoeae in the region. For instance, rates of reduced ceftriaxone susceptibility may be as high as 16.5% in China. 7 It is vital that this evolving situation is continually monitored with good-quality surveillance data.
References1 Ross JD, Radcliffe KW. Why do those using illicit drugs have higher rates of sexually transmitted infection? Int J STD AIDS 2006;17:247-53 Letters to the Editor