Penicillinase-producing Neisseria gonorrhoeae in California. Report of a major outbreak and control recommendations.

A major outbreak of penicillinase-producing Neisseria gonorrhoeae occurred in California beginning in late 1986. After a state public health emergency was declared in April 1987, a statewide, cooperative federal-state-local treatment and control program was implemented. It was successful in reducing the reported incidence by 59%. Despite the success of this effort, penicillinase-producing N gonorrhoeae is not controlled in California, and, while not nearly the magnitude reported in Florida, an increasing number of cases are again being reported in California. We present recommendations for clinicians and local public health officials, including the epidemiologic and empiric treatment of suspected gonorrhea cases with ceftriaxone when the incidence of penicillinase-producing gonococcal cases in a community exceeds 1% of all reported gonorrhea cases.