Background. Neisseria gonorrhoeae, a sexually transmitted infection, is associated with adverse pregnancy and neonatal outcomes. Emerging resistance towards various antibiotics has been observed globally. However, there is a lack of data on antimicrobial susceptibility patterns in N. gonorrhoeae isolated from pregnant women in our setting. This study fills in this gap in the literature. Methods. The study population included pregnant women, recruited from the antenatal clinic of the King Edward VIII hospital (KEH) in Durban. Endocervical swabs were obtained from 307 women. The swab was placed in Amies Charcoal media for culture assessments. Pure isolates of N. gonorrhoeae were subjected to antimicrobial susceptibility testing using the Etest™ method. The MIC values were assessed in accordance with the European Committee on Antimicrobial Susceptibility Testing (EUCAST, 2019) breakpoints. Results. The prevalence of N. gonorrhoeae by culture was 1.9%. High MIC values to penicillin G (12-64 mg/L) indicating a resistant phenotype were observed for all isolates tested, with 50% of the isolates displaying complete resistance. Isolates with intermediate (1 mg/L) and resistance (1.9-32 mg/L) profiles to tetracycline were observed. Resistance to ciprofloxacin (1.16-3 mg/L) was also observed. Isolates displayed either dual or triple resistance to penicillin G, tetracycline, or ciprofloxacin. All isolates showed susceptibility to spectinomycin (>64 mg/L), azithromycin (1 mg/L), ceftriaxone (>0.125 mg/L), and cefixime (>0.125 mg/L). Conclusion. Despite lack of resistance to ceftriaxone and azithromycin, continuous surveillance for emerging patterns of resistance to these antibiotics is needed since they form part of the treatment guidelines.

Objective The global emergence of drug resistance in Neisseria gonorrhoeae has resulted in the use of a range of antibiotics and is now a public health concern because this pathogen may become untreatable in the future. This study aimed to detect antimicrobial-resistant determinants in N. gonorrhoeae directly from endocervical specimens. Methods Three hundred seven pregnant women were enrolled in this study. Endocervical swabs were collected from consenting women and used for the detection of N. gonorrhoeae. Molecular indicators associated with penicillin, tetracycline, ciprofloxacin, azithromycin, spectinomycin, cefixime, and ceftriaxone resistance were detected by polymerase chain reaction. Results Of the 307 women, 24 (7.8%) tested positive for N. gonorrhoeae. The tetM gene carried on the American-type plasmid was shown to be present in all the specimens. Approximately 87.5% of the specimens carried the penicillinase-producing African-type plasmid, and the gyrase A gene carrying the Ser-91 mutation was shown to be present in 37.5% of the specimens. Mutations associated with azithromycin, spectinomycin, cefixime, and ceftriaxone resistance were not detected in the study specimens. Conclusion The detection of resistance determinants without the need for culture may prove to be more feasible for future epidemiological investigations focused on tracking antimicrobial susceptibility patterns in N. gonorrhoeae.

Background: The global emergence of antimicrobial resistance (AMR) in Neisseria gonorrhoeae to various antibiotics is a public health concern. To date, there have been no published South African studies that have compared the primary swab to the cultured isolates for the detection of N. gonorrhoeae AMR determinants. This study provides data on such a comparison. Methods: Paired endocervical swabs were collected from 307 pregnant women. The first swab was stored in an Amies charcoal transport media for culture assessment and the second swab was used for the molecular detection of resistant determinants. Specific targets (genes/plasmids/mutations) associated with resistance to penicillin, tetracycline, ciprofloxacin, spectinomycin, cefixime, azithromycin and ceftriaxone were detected from both the cultured isolates and the endocervical swabs. Results: Of the 307 samples tested in this study, only six samples tested positive for culture. A total of 24 samples tested positive for N. gonorrhoeae with the quantitative polymerase chain reaction (qPCR) assay. The six samples which tested positive for culture fell within the qPCR positives group. Since this study was designed to directly compare the culture swabs to the endocervical swabs for the detection of AMR determinants, the current analysis included only the six culture samples and six paired endocervical swab samples (n = 6). All six isolates were resistant to tetracycline and penicillin G while five of the six isolates were resistant to ciprofloxacin. All isolates were susceptible to the remaining antimicrobials. There was a 100% correlation between the cultured isolates and endocervical swabs for detecting the specific AMR determinants, conferring resistance to tetracycline, penicillin G and ciprofloxacin. Conclusion: Based on the findings of this study, tracking emerging patterns of resistance from the molecular level using only the endocervical swabs may serve as an attractive future research direction.

The detection of Neisseria gonorrhoeae using culture assays is challenging. This study aims to compare different assays for the detection of N. gonorrhoeae. This cross-sectional study was conducted at King Edward VIII Hospital and included 307 antenatal attendees, each willing to provide two endocervical swabs. The first swab was used for culture identification of N. gonorrhoeae, and the second swab was processed for the detection of the pathogen by the TaqMan quantitative polymerase chain reaction (qPCR) assay, an in-house 16S ribosomal RNA ( rRNA) PCR and PCR detection of the opa gene. Culture and the nucleic acid amplification assays were each used as comparator tests in the analysis. Sensitivity and specificity were calculated using RS Studio. The prevalence of N. gonorrhoeae was 7.8%. When compared to the TaqMan assay, the 16S rRNA PCR exhibited the highest sensitivity of 62%, with a substantial level of agreement (kappa level of agreement: 0.60), followed by the opa PCR (38%) with a moderate level of agreement (0.52) and culture exhibiting the lowest sensitivity of 25% with a fair level of agreement (0.38). The diagnostic accuracy of all the assays was >90%. The TaqMan qPCR assay has the ability to serve as a future diagnostic assay for the detection of N. gonorrhoeae.