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National Notifiable Diseases Surveillance System, 2004
Annual report
In 2004, a total of 3,640 isolates of gonococci were
tested for antibiotic susceptibility. Eighty-fi ve per
cent of isolates were from men, of which 76 per
cent were obtained from the urethra, 13 per cent
from the rectum and 8 per cent from the larynx. In
females, 92 per cent of isolates were obtained from
the cervix.
Trends in the proportion of isolates resistant to
penicillin, quinolones and tetracycline are shown in
Table 14. In 2004, the proportion of isolates resistant
to penicillin by plasmid mediated resistance and
chromosomally mediated resistance increased by
23 and 17 per cent, respectively. Quinolone resistance
also increased by 61 per cent, 92 per cent of
which were resistant at a higher ‘minimal inhibitory
concentration’ (MIC) (1 mg/L or more). This is of concern
as quinolones (e.g. 500 mg of ciprofl oxacin),
still used for treatment in Australia, will not be effective
in high level quinolone resistant isolates.
In 27 per cent of infections by strains with plasmid
mediated resistance to penicillin and in 64 per
cent of infections by strains resistant to quinolone,
information on country where resistant strains were
acquired were available. This showed that 48 per
cent (51/106) of plasmid mediated resistance were
locally acquired with the rest acquired from South or
South East Asia. Sixty per cent of quinolone resistant
strains were acquired locally and the remaining
from overseas.
The distribution of infections with strains resistant
to different antibiotic agents varies from jurisdiction
to jurisdiction and urban to rural areas within each
jurisdiction. The AGSP recommends that treatment
regimes should be tailored to the local patterns of
susceptibility. Nationally, the AGSP recommends
the use of alternative treatments to quinolones for
infections acquired.
Syphilis (all categories)
In 2004, all jurisdictions began reporting to NNDSS
syphilis infections categorised as: infectious syphilis
of less than two years duration; and syphilis of
more than two years or unknown duration. Detailed
analysis will be reported for the two categories, as
well as for syphilis of all categories for the purpose
of showing trends in keeping with reports in previous
years.
In 2004, a total of 2,296 cases of syphilis infection
of all categories were reported, representing a notifi
cation rate of 11.4 cases per 100,000 population,
an increase of 13 per cent on the 10.1 cases per
100,000 reported in 2003 (Table 3). The Northern
Territory continues to have the highest notifi cation
rate of syphilis (142 cases per 100,000 population),
although in 2004 the rate was lower by 13 per cent
from the previous year. In 2004, there were increases
in notifi cation rates only in New South Wales (by
24%), in Western Australia (by 43%) and in Victoria
(by 18%). At the regional level, the highest notification
rate was in the Kimberley Statistical Division of
Western Australia at 344 cases per 100,000 population
(Map 5).
Table 14. Proportion of gonococcal isolates showing antibiotic resistance, Australia, 1998 to 2004
Year
Penicillin resistance
(% resistant)
Plasmid mediated Chromosomally
mediated
Quinolone resistance
(% resistant)
High level tetracycline
(% resistant)
1998 5.3 21.8 5.2 NR
1999 7.4 14.3 17.2 7.9
2000 8.7 10.6 17.8 9.1
2001 7.5 15.3 17.5 9.4
2002 7.1 10.9 10.0 11.4
2003 9.0 9.0 14.4 11.2
2004 11.1 10.6 23.3 13.8
Source:
NR
Australian Gonococcal Surveillance Programme.
Not reported.
CDI Vol 30 No 1 2006 41