International Travel and Sexually Transmitted Disease

into the selection frequency of resistant mutants and the bacterial kill rate by lev-ofloxacin and ciprofloxacin in non-mucoid Pseudomonas aeruginosa isolates from cystic fibrosis patients. In vitro pharmacodynamic modeling simulating free serum concentrations of fluoro-quinolones against multidrug-resistant Streptococcus pneumoniae. a novel fluoro-quinolone, activity against important respiratory tract pathogens. In vitro activity of newer fluoroquinolones for respiratory tract infections and emerging patterns of antimi-crobial resistance data from the Sentry antimicrobial surveillance program. Pharmacodynamic comparisons of lev-ofloxacin, ciprofloxacin, and ampicillin against Streptococcus pneumoniae in an in vitro model of infection. Pharmacodynamics of fluoroquinolones against Streptococcus pneumoniae in patients with community-acquired respiratory tract infections. Phenotypic resistance of penicillin-susceptible and penicillin-resistant Streptococcus pneumoniae after single and multiple in vitro exposures to ciprofloxacin, gati-and trovafloxacin against Streptococcus pneumoniae in a dynamic in vitro model.resistance among fluoroquinolone-resistant clinical isolates of Streptococcus pneumo-niae. Characterization of U.S. clinical Strepto-coccus pneumoniae strains from 2000–2001 that are cross-resistant to ciprofloxacin, gatifloxacin, levofloxacin, and moxifloxacin. Annual Meeting single mutations in topoisomerase type II genes among levofloxacin-susceptible clinical isolates of Streptococcus pneumoniae et al. Molecular epidemiology and evolution of resistance to quinolones in Escherichia coli after prolonged administration of ciprofloxacin in patients with pro-statitis. Activities of gatifloxacin compared to those of seven other agents against anaerobic organisms. of fluoroquinolones in a mixed infection simulationg an artificial bowel: effect of eradicating Bacteroides fragilis. American Society for Microbiology, 2002, Abstract A-145. To the Editor: Recent articles in the professional literature (1–3) have offered advice regarding the importance of taking a careful travel history, particularly in this time of unprecedented levels of international travel 1654 Emerging Infectious Diseases • LETTERS (4). Such screening serves an important public health purpose as well, especially for sexually transmitted disease (STD) control. Sexual behaviors associated with travel can change the level of risks for STD transmission (5–7), and the epidemiology of STDs is not uniform throughout the world (8,9). These geographic differences may increase the risk of a traveler's becoming infected, or, conversely, increase the risk of a traveler's introducing a sexually transmitted pathogen, possibly one that is resistant to treatment, into a low-incidence area (10). In addition, different strains of pathogens may be common in different parts of the world (11–14). For example, quinolone-resistant Neisseria gonor-rhoeae (QRNG) is much more common in Asia (up to 40% of all isolates) (15). These strains of QRNG were first introduced in the United States by persons who engaged in sexual activity …