Abstract
Objectives:Successful treatment of gonorrhea has always been jeopardized by the emergence of resistance to antibiotics recommended as first-line therapies. The present investigation was carried out to demonstrate the current status of antimicrobial susceptibility of N. gonorrhoeae with a special reference to azithromycin and ceftriaxone.Methods:Microscopical detection in Gram-stained smear and isolation by culture in Thayer-Martin medium were done for 60 clinically suspected gonorrhea patients using urethral discharge or prostatic secretion for male and endocervical secretion for female. Isolates of N. gonorrhoeae were subjected to antimicrobial susceptibility testing by modified Kirby Bauer disk diffusion method against eight antimicrobial drugs including azithromycin and ceftriaxone.Results:Culture yielded a total of 25(42%) isolates of N. gonorrhoeae from 60 clinically suspected patients of both sexes; 21 from male (17 from urethral discharge and 04 from prostatic secretion) and 04 from female (endocervical secretion). Isolates of N. gonorrhoeae showed moderate to high resistance (60 to 88%) to penicillin, tetracycline, cotrimoxazole, erythromycin, ciprofloxacin and cefixime. While resistance to azithromycin and ceftriaxone was 60% and 48% respectively, which was also moderate.Conclusion:Our findings indicate moderate to the high resistance of N. gonorrhoeae to conventional antibiotics. It also showed moderate resistance to azithromycin and ceftriaxone, current dual therapy recommended by the WHO for the treatment of genital gonorrhea, which is alarming.
Highlights
Gonorrhea caused by Neisseria gonorrhoeae (N. gonorrhoeae) is the second most common sexually transmitted infection (STI) worldwide
Antimicrobial disks (Oxoid, UK) of penicillin(10μg), tetracycline (30μg), erythromycin(15μg), cotrimoxazole(25μg),ciprofloxacin(5μg), cefixime (5μg), azithromycin (15μg) and ceftriaxone(30μg) were selected as per Clinical and Laboratory Standard Institute (CLSI) 2016 guideline.11Inoculated plates with the antimicrobial disks were incubated at 370C for 1824 hours in a humid atmosphere with 5-10% CO2 provided by a candle jar
We noted moderate resistance to azithromycin (60%) and ceftriaxone (48%), the current dual therapy for gonorrhea in our present investigation.Our results show much higher rate of resistance for these two drugs in comparing with contemporary research findings which is alarming though but not unusual for a pathogen like N. gonorrhoeae
Summary
Gonorrhea caused by Neisseria gonorrhoeae (N. gonorrhoeae) is the second most common sexually transmitted infection (STI) worldwide. The precise global burden of N. gonorrhoeae is difficult to estab-. The World Health Organization (WHO) estimates that in each year 78 million new cases of gonorrhea occur among adolescents and adults aged 15-49 years worldwide with a global incidence rate of 19 per 1000 females and 24 per 1000 males. In South-East Asia, each year 11.4 million new cases of gonorrhea were estimated.[1] In Bangladesh, the prevalence rate of gonorrhea is not well documented but it was found to be 27.81% among STIs and second only to non-gonococcal urethritis (NGU) noted in a retrospective large-scale study incorporating data from 2003 to 2011 at a tertiary care hospital.[2] Gonorrhea
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