Lower-extremity lymphedema and elevated body-mass index.

To the Editor: In their summary of the global threat of antibiotic-resistant Neisseria gonorrhoeae, Bolan et al. (Feb. 9 issue)1 state that “in patients who are allergic to cephalosporins, the only option is 2 g of azithromycin orally.” However, the aminoglycoside spectinomycin (unavailable in the United States since 2006) has proven efficacy against genital gonococcal infection2 and is recommended for patients in the United Kingdom who are allergic to penicillin.3 Since most gonococcal isolates remain susceptible to spectinomycin, it represents a viable option for cephalosporinresistant genital gonorrhea,2,3 although ongoing uncertainty regarding manufacturing and supply may compromise its future usefulness.4 In addition, reduced efficacy against pharyngeal infection has been observed.2 On a practical level, determining each isolate’s specific antimicrobial sensitivity profile in the context of penicillin allergy or third-generation cephalosporin resistance is advisable, since cephalosporin-resistant isolates may retain susceptibility to other common agents.3