Neisseria gonorrhoeae among suspects of sexually transmitted infection in Gambella hospital, Ethiopia: risk factors and drug resistance

Abstract

BackgroundNeisseria gonorrhoeae is a bacterium responsible for one of the classic sexually transmitted infection (STI) gonorrhea. Antibiotic resistant strains are emerging at alarming rate. Multiple sexual partners, unsafe sex and substance use habits are the main host related risk factors for acquiring the infection. Thus, this study aimed at determining the magnitude, its determinants and antimicrobial resistance profile of N. gonorrhoeae in a place where there is risk related cultural practices and relatively high HIV prevalence.MethodsA cross-sectional study was conducted on 186 STI suspected patients seen in Gambella hospital from March to July 2015. Data on socio-demographic characteristics and associated risk factors was collected using pre-designed questionnaire. Urethral or endo-cervical swabs were collected aseptically by trained nurses. Then, samples were transported to laboratory and processed within 15 min following standard microbiological culture techniques. Antimicrobial susceptibility test was performed by using Kirby-Bauer disk diffusion method. Data entry, transforming and analysis was done using SPSS version 20.ResultsIn this study 11.3 % of the STI suspected patients were confirmed to have N. gonorrhoeae. The rate of infection in males was four times higher than in females accounting 16.0 and 5.0 % respectively (p = 0.049). It was also higher (18.9 %) in 20–24 years age group (p = 0.439). Alcohol intake (p = 0.013), less frequent condom use (p = 0.031), and multiple sex partners (p = 0.024) were associated with increased odds of infection. All N. gonorrhoeae isolates were susceptible to ceftriaxone and cefoxitin but all were resistant to penicillin and tetracycline. Alarmingly, 28.6 % of the isolates were resistant to ciprofloxacin.ConclusionsThe proportion of urogenital symptoms attributable to N. gonorrhoeae was high (11 %), with highest prevalence among males and young adults. Hence, prevention efforts should consider behavioral risk reduction. Ceftriaxone and cefoxitin can be considered as excellent first-line treatment options. However, alarming rate of resistance to ciprofloxacin challenges the current use of this antibiotic in the syndromic management package of gonococcal infections. Thus, laboratory based diagnosis and treatment system is need.

Neisseria Gonorrhoae and their antimicrobial susceptibility patterns among symptomatic patients from Gondar town, north West Ethiopia

“…The antimicrobial resistance patterns ranged from 7(28%) for Cefotaxime and Clindmycin up to 100% in Tetracycline. This Tetracycline resistance pattern was similar with the study done in Gambella hospital, Ethiopia [ 1 ]. The present study showed a high level of resistance to Tetracycline 25(100%) and Ciprofloxacin 13(52%) compared to the study done in North West Ethiopia (92.6, 40.9%) (15), Southern Ethiopia (55, 18%) [ 2 ] and United States (25.3, 19.2%) [ 4 ].…”

“…Neisseria gonorrhoeae is a Gram negative, coffee-bean shaped intracellular diplococcus bacterium responsible for gonorrhoea which is one of the classical sexually transmitted infections (STIs) [ 1 ]. The causative organism is highly adapted to the genital tract and often causing asymptomatic and undetected infection [ 2 ].…”

“…Gonorrhoea is acquired by unsafe sex practices and also can be transmitted from mother to child during delivery [ 1 ], which has medically significant implications if not treated early. Untreated gonorrhoea can lead infertility, inflammation leading to acute and chronic abdominal pain in women, ectopic pregnancy and maternal death, first trimester abortion, severe neonatal eye infection that lead to blindness, a fivefold increase in HIV transmission, disseminated gonococcal infection which results in localized septic arthritis, endocarditis, and meningitis [ 1 , 3 , 4 ]. Therefore, accurate efforts should be made to offer routine endocervical cultures for N. gonorrhoeae to all women who have risk behavior of STIs to prevent this infection [ 5 ].…”

Prevalence and antimicrobial susceptibility patterns of Neisseria gonorrhea among the Symptomatic Patients attending Outpatient Department in Lyatonde District Hospital Southwestern Uganda

“…The overall yield of N. gonorrhea isolates of 4.9% in the whole study population is lower than that found in studies conducted elsewhere in some African countries; 11.3% and 5.1% in Ethiopia, 8.4% in Tanzania, 42% in Bangladesh, 59% in Uganda and 80% Malawi. [17][18][19][20][21] The variation in prevalence rates in those other studies compared to the current study may be due to differences in the study population where pregnant women with urethral discharges attending antenatal clinics in Uganda, the antiretroviral therapy follow up cases in Ethiopia, patients only with urethral discharge in STI clinics in Malawi, and commercial sex workers in Bangladesh.…”

“…This finding is in concordance with studies conducted in some parts of Africa. 17,18 Although we never looked for factors influencing propensity to N. gonorrhea infection, some studies have reported sexual promiscuity of males as they tend to have more sexual partners compared to their female sexual counter parts. 27 Besides, by nature males are more symptomatic for the infection than their female counterparts.…”