Emergence of Haemophilus ducreyi resistance to trimethoprim-sulfamethoxazole in Rwanda

Dyck, E Van; Bogaerts, J.; Smet, Hilde; Tello, W Martinez; Mukantabana, V.; Piot, Peter

doi:10.1128/aac.38.7.1647

Cited by 15 publications

(4 citation statements)

References 11 publications

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“…One strain with a ciprofloxacin MIC of 2.0 g/ml has been isolated in Thailand (75); however, quinolone resistance does not appear to be widespread. H. ducreyi resistance to TMP-SMX has been reported in Rwanda (166); the prevalence of resistant strains increased from 9% (2 of 23) in 1988 to 48% (34 of 71) of strains examined in 1991. All of the TMP-SMXresistant isolates were resistant to TMP (MIC, Ͼ4.0 g/ml).…”

Section: Treatmentmentioning

confidence: 97%

Chancroid and Haemophilus ducreyi: an update.

Trees

Morse

1995

Clinical Microbiology Reviews

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Section: Treatmentmentioning

confidence: 97%

Chancroid and Haemophilus ducreyi: an update.

Trees

Morse

1995

Clinical Microbiology Reviews

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“…Our clinicians did suspect chancroid in a few cases, but the service program did not record detailed descriptions or photographs of ulcers and we lacked laboratory diagnostics. The most recent [55][56][57][58][59]. For many years the prevalence of HD had been decreasing in much of Africa [48,54], but recent publications indicate HD may be staging a comeback [21].…”

Section: Plos Onementioning

confidence: 99%

Etiologies of genital inflammation and ulceration in symptomatic Rwandan men and women responding to radio promotions of free screening and treatment services

et al. 2021

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Introduction The longstanding inadequacies of syndromic management for genital ulceration and inflammation are well-described. The Rwanda National Guidelines for sexually transmitted infection (STI) syndromic management are not yet informed by the local prevalence and correlates of STI etiologies, a component World Health Organization guidelines stress as critical to optimize locally relevant algorithms. Methods Radio announcements and pharmacists recruited symptomatic patients to seek free STI services in Kigali. Clients who sought services were asked to refer sexual partners and symptomatic friends. Demographic, behavioral risk factor, medical history, and symptom data were collected. Genital exams were performed by trained research nurses and physicians. We conducted phlebotomy for rapid HIV and rapid plasma reagin (RPR) serologies and vaginal pool swab for microscopy of wet preparation to diagnose Trichomonas vaginalis (TV), bacterial vaginosis (BV), and vaginal Candida albicans (VCA). GeneXpert testing for Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) were conducted. Here we assess factors associated with diagnosis of NG and CT in men and women. We also explore factors associated with TV, BV and VCA in women. Finally, we describe genital ulcer and RPR results by HIV status, gender, and circumcision in men. Results Among 974 men (with 1013 visits), 20% were positive for CT and 74% were positive for NG. Among 569 women (with 579 visits), 17% were positive for CT and 27% were positive for NG. In multivariate analyses, factors associated with CT in men included younger age, responding to radio advertisements, <17 days since suspected exposure, and not having dysuria. Factors associated with NG in men included not having higher education or full-time employment, <17 days since suspected exposure, not reporting a genital ulcer, and having urethral discharge on physical exam. Factors associated with CT in women included younger age and < = 10 days with symptoms. Factors associated with NG in women included younger age, lower education and lack of full-time employment, sometimes using condoms vs. never, using hormonal vs. non-hormonal contraception, not having genital ulcer or itching, having symptoms < = 10 days, HIV+ status, having BV, endocervical discharge noted on speculum exam, and negative vaginal wet mount for VCA. In multivariate analyses, only reporting >1 partner was associated with BV; being single and RPR+ was associated with TV; and having < = 1 partner in the last month, being pregnant, genital itching, discharge, and being HIV and RPR negative were associated with VCA. Genital ulcers and positive RPR were associated with being HIV+ and lack of circumcision among men. HIV+ women were more likely to be RPR+. In HIV+ men and women, ulcers were more likely to be herpetic rather than syphilitic compared with their HIV- counterparts. Conclusions Syndromic management guidelines in Rwanda can be improved with consideration of the prevalence of confirmed infections from this study of symptomatic men and women representative of those who would seek care at government health centers. Inclusion of demographic and risk factor measures shown to be predictive of STI and non-STI dysbioses may also increase diagnostic accuracy.

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“…50 There is little, if any, antimicrobial surveillance occurring in countries where chancroid is common. Based on the emergence of resistant strains in Rwanda, 51 the WHO has recommended that chancroid is not treated with trimethoprim/sulfamethoxazole based regimens unless the antimicrobial susceptibility profiles of local H ducreyi isolates are known. 42 Fluctuant buboes should be aspirated in order to provide symptomatic relief for the patient and to avoid the further complication of spontaneous rupture.…”

Section: Treatmentmentioning

confidence: 99%