Abstract
IntroductionGonorrhea is a major sexually transmitted infection (STI) globally with increasing trends. Despite limited data, gonorrhea remains an important public health problem in Bhutan.MethodsA descriptive study was carried out in two Bhutanese hospitals; Jigme Dorji Wangchuck National Referral Hospital and Phuentsholing General Hospital in 2015. Patients suspected of gonococcal urethritis were sampled, treated and followed up at two weeks. Gonococcal isolates were identified and tested for antibiotic susceptibility by the Calibrated Dichotomous Sensitivity Test (CDS) method.ResultsOf the 524 patients, 2.3% (12) were females. Most (46.6%) patients belonged to the 26–35 years age group. About 58% were lost to follow up; 62% (277) of males and all (12) females. N. gonorrhoea was positive in 76% (398) of microscopy and 73.1% (383) by culture. Resistance against ciprofloxacin, penicillin, tetracycline and nalidixic acid were 85.1%, 99.2%, 84.8% and 99.7% respectively. Nearly all the isolates were sensitive to cefpodoxime, ceftriaxone and azithromycin. Sixty-seven percent (350) were treated with injection ceftriaxone alone, 32% (169) with ceftriaxone and oral doxycycline and 1% (5) with ceftriaxone, doxycycline and metronidazole. Probable treatment failure was seen only in one patient (0.5%).ConclusionsGonococcal resistance to currently used antibiotics was low and there was a high clinical cure rate. Compliance to treatment guidelines need reinforcement addressing antibiotic regimen, tracing sexual partners and addressing the social stigma. National STI programs should be more women-friendly for effective management, prevention and control of STIs. Laboratories must adopt more reliable susceptibility testing methods, the Minimum Inhibition Concentration method.
Highlights
Most the isolates were sensitive to cefpodoxime, ceftriaxone and azithromycin
Antibiotic resistance in N. gonorrhoea has followed the same pattern over years, with the introduction of each new therapeutic agent followed by the development of resistance within a few years [3]
Resistance to penicillin and tetracycline emerged in Asia as early as 1970 and to fluoroquinolones in the mid-1990s, resistance to both becoming widespread globally
Summary
A descriptive study was carried out in two Bhutanese hospitals; Jigme Dorji Wangchuck National Referral Hospital and Phuentsholing General Hospital in 2015. Patients suspected of gonococcal urethritis were sampled, treated and followed up at two weeks. Gonococcal isolates were identified and tested for antibiotic susceptibility by the Calibrated Dichotomous Sensitivity Test (CDS) method. A descriptive study was carried out in two large hospitals in Bhutan; the Jigme Dorji Wangchuck National Referral Hospital (JDWNRH) in Bhutan’s capital city, Thimphu and Phuentsholing General Hospital (PGH) located in the commercial city of Phuentsholing bordering India (Fig 1) from January-December 2015. A study protocol and information collection details were developed by reviewing previous literature and adapting to the local setting. Laboratory and pharmacy staff were briefed on the study before commencement in both the hospitals
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