Gonococcal resistance: evolving from penicillin, tetracycline to the quinolones in South Africa – implications for treatment guidelines

Abstract

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.

Antimicrobial susceptibility patterns of gonococcal isolates in Pretoria, South Africa, over a 20-year period (1984-2004)

“…As reported in the study of 2004, 12 all isolates remained susceptible to cefoxitin, ceftriaxone, cefpodoxime and spectinomycin. Ceftriaxone proved to be the most active agent with MIC 90 values of 0.004 mg/l.…”

“…12 The patients were men attending the primary health care clinics and private medical practitioners in the city of Pretoria.…”

Co-Infection with Neisseria gonorrhoeae, Chlamydia trachomatis and Trichomonas vaginalis in Symptomatic South African Men with Urethritis: Implications for Syndromic Management

“…These guidelines are widely used by public health service providers working at Primary Health Clinics as well as private and family practitioners. The prevalence of co-infections with common aetiological agents of male urethritis as well as antimicrobial susceptibility profiles [5] informs therapeutic guidelines and especially syndromic management.…”

“…The local isolates were resistant to the commonly used therapeutic agents and we advocated a change in the national treatment guidelines for N. gonorrhoeae [5]. To determine the prevalence of coinfections in men with urethritis, molecular assays were used in view of the higher sensitivity of detection.…”

Revision of the national guideline for first-line comprehensive management and control of sexually transmitted infections: what's new and why?

“…4 Subsequent surveys also revealed significant levels of quinolone resistance in Gauteng, the Western Cape and the Eastern Cape. [5][6][7] In Johannesburg and Cape Town in 2007, the isolation of QRNG was significantly associated with HIV seropositivity. 7 Among the 491 men with urethral discharge who participated in the surveys, HIV seropositivity was detected at a prevalence of 39% in Johannesburg and 25% in Cape Town (author's unpublished data).…”