Resistant Neisseria gonorrhoeae has been evolving. This study assessed the antimicrobial susceptibility profile of isolates in the Pretoria region, South Africa. Isolates of N. gonorrhoeae from men with urethritis were tested for susceptibility to eight antimicrobial agents by disc diffusion, Etest and agar dilution methods. Chromosomal resistance to penicillin was found in 16% of isolates, 16% showed plasmid-mediated resistance and decreased susceptibility was seen in 73% of isolates. For the first time, there is evidence of high-level tetracycline resistance (36%). Ciprofloxacin resistance emerged at 7%. All isolates remained susceptible to ceftriaxone. In view of these findings of the emergence of quinolone-resistant N. gonorrhoeae, national treatment guidelines for syndromic management of sexually transmitted infections need to be urgently reviewed. The injectable preparation, ceftriaxone has to be considered as a first-line agent for the management of gonococcal infections. Overall, the gonococcal isolates in the Pretoria region remain susceptible to ceftriaxone, cefoxitin, cefpodoxime and spectinomycin.

This study was undertaken to assess the risk of being infected with a known sexually transmitted pathogen at the time of presentation for termination of pregnancy. Endocervical and vaginal swabs were collected for the diagnosis of Neisseria gonorrhoeae, Chlamydia trachomatis and Trichomonas vaginalis. Single infections were found in 21.5% of the women, with C. trachomatis being the commonest (10.0%). Mixed infections were found in nine women, with trichomoniasis and chlamydial infections in six. During speculum examination, vaginal discharge was observed in 73% of the women. The commonest organism detected in patients with vaginal discharge was C. trachomatis (11.6%), while T. vaginalis (11.1%) was the most common in women without visible vaginal discharge. No significant differences were found when comparing symptomatic and non-symptomatic women. This study strongly recommends that women presenting for termination of pregnancy be screened for STIs and receive relevant sexual health education.

Abstract:Background: This study was undertaken to determine co-infection rates of common aetiological agents of urethritis and information regarding sexual contacts of symptomatic males presenting to a family practitioner. Methods: Endo-urethral swab specimens were collected from 253 symptomatic men and tested for N. gonorrhoeae, C. trachomatis by the BD ProbeTec ™ ET assay and for T. vaginalis by real-time PCR. Information regarding sexual behaviour was collected by the practitioner using a structured interview. Results: Of the 253 patients investigated, 50 complained of urethral discharge with/without burning on micturition (BOM), the remaining 203 only complained of BOM. N. gonorrhoeae was isolated from 45%, C. trachomatis from 15% and T. vaginalis from 5.5%. N. gonorrhoeae/C. trachomatis co-infection was diagnosed in 7.5% and T. vaginalis was detected in a higher number of males presenting without visible discharge. Similar number of men reported sexual contact only with their wives compared to men having casual sexual contacts. There were fewer gonococcal infections in men reporting sexual contact with their wives alone compared to men reporting casual sexual encounters. Conclusions: Treatment guidelines for men presenting to Primary Health Care facilities and Family Practitioners need to consider the evolving antimicrobial resistance profiles and the presence of mixed infections in symptomatic patients.

Gonococcal isolates resistant to ciprofloxacin collected from 2004 to 2005, in the Pretoria region, were characterised using Neisseria gonorrhoeae multi-antigen sequence typing (NG-MAST). The isolates were obtained from men presenting with urethritis to primary healthcare clinics and general practitioners. All isolates were tested for susceptibility to ciprofloxacin by Etest, disc diffusion and agar dilution methods. Sequence-based typing, directed at the por and tbpB genes, and compared with international isolates using the NG-MAST database on the internet, was done for 18 isolates (10 ciprofloxacin-resistant isolates and 8 susceptible controls). There was one cluster (four isolates) of known sequence type (ST) similar to the pattern seen among strains from Scotland, England, and Durban, South Africa. Two other known STs were identified, while the remaining STs were unique.

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