Abstract
Background: In South Africa, sexually transmitted infections (STIs) are managed through a syndromic approach at primary healthcare centres (PHCs). Neisseria gonorrhoeae is the predominant cause of male urethritis syndrome. We describe antimicrobial resistance patterns and trends in Neisseria gonorrhoeae during a ten-year surveillance period at a large PHC in Johannesburg. Methods: Neisseria gonorrhoeae was cultured from genital discharge swab specimens obtained from consenting adult patients presenting at the Alexandra Health Centre in Johannesburg between 2008 and 2017. Isolates were tested for antimicrobial susceptibility by Etest™ (cefixime, ceftriaxone, ciprofloxacin) or agar dilution (penicillin, tetracycline, azithromycin). Results: During the period of surveillance, high-level resistance prevalence increased from 30% to 51% for penicillin (p-value for trend < 0.001), 75% to 83% for tetracycline (p-value for trend = 0.008), and 25% to 69% for ciprofloxacin (p-value for trend < 0.001). Analysis did not reveal high-level resistance to spectinomycin or a minimum inhibitory concentration (MIC) creep for extended-spectrum cephalosporins, and the prevalence of intermediate-resistance to azithromycin was less than 5%. Conclusions: High prevalence resistance to penicillin, tetracycline, and ciprofloxacin in N. gonorrhoeae obviates their use in future national treatment algorithms for genital discharge. It is essential to continue monitoring for emerging resistance to currently recommended antimicrobial therapy in this rapidly evolving pathogen.
Highlights
Gonorrhoea is a major public health concern worldwide
We describe Neisseria gonorrhoeae antimicrobial resistance patterns and trends from Johannesburg
Neisseria gonorrhoeae isolates from 2445 unique individuals were tested between 2008 and 2017
Summary
Gonorrhoea is a major public health concern worldwide. The infection has a short incubation period of a few days, as well as a high transmission efficiency, and leads to a fivefold increase in HIV transmission and complications such as pelvic inflammatory disease and infertility, which compound the global health burden [1]. The World Health Organisation (WHO) 2012 prevalence data for curable sexually transmitted infections revealed that the estimated global prevalence of gonorrhoea among women aged 15–49 years was 0.8% (95% uncertainty interval 0.6–1.0%) and among males aged. Penicillin was first used in the 1940s and tetracycline from the 1950s to the 1980s, but high-level plasmid-mediated resistance to both agents was being described by the 1980s. We describe antimicrobial resistance patterns and trends in Neisseria gonorrhoeae during a ten-year surveillance period at a large PHC in Johannesburg. Results: During the period of surveillance, high-level resistance prevalence increased from 30% to 51% for penicillin (p-value for trend < 0.001), 75% to 83% for tetracycline (p-value for trend = 0.008), and 25% to 69% for ciprofloxacin (p-value for trend < 0.001). Conclusions: High prevalence resistance to penicillin, tetracycline, and ciprofloxacin in N. gonorrhoeae obviates their use in future national treatment algorithms for genital discharge. It is essential to continue monitoring for emerging resistance to currently recommended antimicrobial therapy in this rapidly evolving pathogen
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