Gonorrhea among Men Who Have Sex with Men: Outbreak Caused by a Single Genotype of Erythromycin‐ResistantNeisseria gonorrhoeaewith a Single–Base Pair Deletion in themtrRPromoter Region

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Abstract
During 1995–1997, an outbreak of 66 cases of gonorrhea caused by an erythromycin-resistant (Eryr; MIC ⩾ 1.0 μg/mL) prototrophic (proto) auxotype IB-1 serovar of Neisseria gonorrhoeae occurred in King County, Washington; 65 cases involved men who have sex with men (MSM), which accounted for ∼37% of infections among MSM during this period. Isolates from 19 of these 65 cases of infection were analyzed by DNA sequencing of the polymerase chain reaction-amplified promoter region of the mtrR gene and by pulsed-field gel electrophoresis (PFGE) analysis of genomic DNA after NheI and SpeI digestion. Eighteen of the 19 isolates had a 1-bp A/T deletion in a 13-bp inverted repeat of the mtrR promoter region and shared a single PFGE type. Among MSM who provided data about sexual behavior, 37 (64%) of 58 MSM infected by the proto/IB-1 Eryr strain reported having >2 sex partners during the past 60 days, compared with 32 (30%) of 106 MSM infected by other strains (P < .001). This clonal outbreak of gonorrhea illustrates the ongoing need for behavioral preventive interventions among MSM.

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