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Volume 18, Number 8—August 2012

CME ACTIVITY - Research

Factors Related to Increasing Prevalence of Resistance to Ciprofloxacin and Other Antimicrobial Drugs in Neisseria gonorrhoeae, United States

Earning CME Credit

To obtain credit, you should first read the journal article. After reading the article, you should be able to answer the following, related, multiple-choice questions. To complete the questions (with a minimum 70% passing score) and earn continuing medical education (CME) credit, please go to www.medscape.org/journal/eid. Credit cannot be obtained for tests completed on paper, although you may use the worksheet below to keep a record of your answers. You must be a registered user on Medscape.org. If you are not registered on Medscape.org, please click on the New Users: Free Registration link on the left hand side of the website to register. Only one answer is correct for each question. Once you successfully answer all post-test questions you will be able to view and/or print your certificate. For questions regarding the content of this activity, contact the accredited provider, CME@medscape.net. For technical assistance, contact CME@webmd.net. American Medical Association’s Physician’s Recognition Award (AMA PRA) credits are accepted in the US as evidence of participation in CME activities. For further information on this award, please refer to http://www.ama-assn.org/ama/pub/category/2922.html. The AMA has determined that physicians not licensed in the US who participate in this CME activity are eligible for AMA PRA Category 1 Credits™. Through agreements that the AMA has made with agencies in some countries, AMA PRA credit may be acceptable as evidence of participation in CME activities. If you are not licensed in the US, please complete the questions online, print the certificate and present it to your national medical association for review.

Article Title: Increasing Resistance to Ciprofloxacin and Other Antimicrobial Drugs in Neisseria gonorrhoeae, United States

CME Questions

1. You are a consultant to a US public health department regarding development of antibiotic resistance in Neisseria gonorrhoeae. Based on the analysis of data from the Gonococcal Isolate Surveillance Project (GISP) by Dr. Goldstein and colleagues, which of the following statements about overall patterns of drug resistance stratified by sexual orientation is most likely correct?

A. Between 1998 and 2007, ciprofloxacin resistance grew faster for heterosexual men than in men who have sex with men (MSM)

B. The fastest growing class of ciprofloxacin-resistant types in MSM was the type resistant to ciprofloxacin, tetracycline, and penicillin (triply resistant)

C. The mono-resistant type (resistant to ciprofloxacin; sensitive to tetracycline/penicillin) declined overall during the study period

D. In heterosexuals, the mono-resistant type was the most common form of ciprofloxacin resistance since mid 2001

2. Based on the analysis of data from GISP by Dr. Goldstein and colleagues, which of the following statements about recent travel and resistance in MSM and heterosexuals is most likely correct?

A. In MSM, triple resistance prevalence was positively associated with recent travel

B. In heterosexuals, triple resistance prevalence was negatively associated with recent travel

C. The positive association between mono-resistance and recent travel was borderline statistically significant for heterosexuals

D. In MSM, there was a strong, statistically significant association between mono-resistance and recent travel

3. Based on the analysis of data from GISP by Dr. Goldstein and colleagues, which of the following statements about the first appearance of resistance in heterosexuals and MSM would most likely be correct?

A. The timing of first appearance of ciprofloxacin resistance in heterosexuals and in MSM in different GISP sites was not correlated

B. Median delay in timing of first appearance between MSMs and heterosexuals was 5.5 months in either direction, despite a 5-year range of times of first appearance across different sites

C. Correlations were limited to the same geographic regions at the same times

D. The data suggest that prevention efforts should target only MSM

Activity Evaluation

1. The activity supported the learning objectives.

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2. The material was organized clearly for learning to occur.

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3. The content learned from this activity will impact my practice.

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4. The activity was presented objectively and free of commercial bias.

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