FIGURE 2-4 Percentage of fluoroquinolone-resistant Neisseria gonorrhoeae (QRNG)* among tested gonococcal isolates and gonorrhea rate, by year§—Hawaii, 1993–2001.

*Defined as N. gonorrhoeae resistant to ciprofloxacin (minimal inhibitory concentration [MIC] ≥ 1.0 μg/mL or disk diffusion zone size ≤ 27 mm) or ofloxacin (MIC ≥ μg/mL or disk diffusion zone size ≤24 mm) by the Committee on Clinical Laboratory Standards.

Per 100,000 population.

§Data for 1993–2001 include Gonococcal Isolate Surveillance Project (GISP) and non-GISP isolates.

SOURCE: CDC (2002e).


A growing body of evidence supports the hypothesis that infectious agents cause or contribute to many chronic diseases and cancers previously thought to be caused by genetic, environmental, or lifestyle factors (see Table 2-3) (Cassell, 1998; Pisani et al., 1997). Specific microbes claimed to be associated with chronic conditions may be cofactors with other microbes or other etiologic factors in the disease, sometimes being necessary but perhaps not sufficient elements in the causation pathway. The era of molecular biology and intensive research efforts in the field of AIDS have led to powerful advances in technology for the sensitive detection of infectious agents. These diagnostic tools, plus the realization that organisms of otherwise unimpressive virulence can produce slowly progressive chronic disease with a wide spectrum of clinical manifestations and disease outcomes, have resulted in the discovery of new infectious agents and new concepts in the understanding of infectious diseases.

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