UC Berkeley

The development of antimicrobial resistance in Neisseria gonorrhoeae has severely limited the treatment options available for uncomplicated urogenital infection. As of August 2012, dual therapy with an injectable third generation cephalosporin and a macrolide is the only Centers for Disease Control and Prevention recommended treatment regimen for empirical therapy in the United States. Verified treatment failures with oral cephalosporins used for urethral infections and with injectable cephalosporins used for pharyngeal infections have been reported in Asia, Europe and Australia. At this time, there have been no verified treatment failures with injectable cephalosporins in a urethral infection. Isolates with reduced susceptibility to the both oral and injectable cephalosporins have been described in the U.S., but no treatment failures have been described. This dissertation is formatted as three self-contained research papers. The first paper compares Etest to agar dilution for the determination of N. gonorrhoeae minimum inhibitory concentrations. The second paper describes the genotypic and phenotypic surveillance of N. gonorrhoeae resistance to third generation cephalosporins and macrolides in California in 2011. The third paper details the development of a new molecular assay for the detection of genes associated with reduced susceptibility to cephalosporins.