The percentage of quinolone-resistant Neisseria gonorrhoeae isolated in London increased between 2000 and 2003, from 0.9% to 7.9% of total isolates. This increase was investigated by genotyping resistant isolates and comparing demographic and behavioral data. In 2000, resistant isolates predominantly had unique sequence types (STs) that were associated with imported infection, whereas, in 2002 and 2003, large ST clusters of indistinguishable isolates were associated with endemic acquisition. Resistant isolates that belonged to these large clusters were typically from patients who had similar epidemiological characteristics (such as ethnicity and sexual orientation) and behavioral characteristics (such as multiple sex partners and previous gonorrhea). In London, quinolone resistance is no longer associated with importation from areas of high prevalence and is spreading endemically in high-risk groups.
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Received 17 February 2005; accepted 9 May 2005; electronically published 25 August 2005. Presented in part: joint spring meeting of the British Association of Sexual Health and HIV and the American Sexually Transmitted Diseases Association, Bath, United Kingdom, 19–21 May 2004. Potential conflicts of interest: none reported. Financial support: United Kingdom Department of Health (grant to the study); Wellcome Trust (bioinformatic support). B.G.S. is a Principal Research Fellow of the Wellcome Trust. The views expressed in the publication are not necessarily those of the United Kingdom Department of Health. Reprints or correspondence: Dr. Iona Martin, Sexually Transmitted Bacteria Reference Laboratory, Central Public Health Laboratory, Health Protection Agency, 61 Colindale Ave., London NW9 5HT, United Kingdom (firstname.lastname@example.org).