The Clinico-Epidemiological Profile of Patients with Gonorrhoea and Challenges in the Management of Neisseria gonorrhoeae Infection in an STI clinic, Ternopil, Ukraine (2013-2018)

Abstract

Gonorrhea is the second most common sexually transmitted infection spreading worldwide and a serious public health problem. How�ever, further data are required to improve the management of gonorrhea. Our aim was to review the features of gonococcal infection and characterize the challenges of its management. A retrospective descriptive study of the medical records of 136 adult patients with gonorrhea that visited Ternopil Regional Sexually Transmitted Infections Clinic (Ukraine) in 2013-2018 was performed. The male-to-female ratio was 6.6:1. Homosexually-acquired gonorrhoea was 3.7%. Also, most patients acquired gonorrhea in Ukraine (98.4%). The mean infectious period lasted 2-16 days, including the incubation period of 1-9 days and the period from the onset of symptoms to the first visit of the clinic of 1-7 days. The probability of N. gonorrhoeae transmission within the frame of the epidemiologic sexual chain was 1:2.4. Concurrent T. vaginalis (39.7%) and C. trachomatis (2.2%) were detected. HIV and syphilis screening rates were 1.6% and 0.7%, respectively. The examining rate of sexual partners was 11%, testing extragenital specimens - 0.7%, screening coverage for HIV - 46.3%, compliance with follow-up visits - 41.9%. Part of patients (16.2%) received monotherapy with clarithromycin, doxycycline, benzylpenicillin, azithromycin, or ofloxacin. The management of N. gonorrhoeae infections was compromised by a low rate of examining sexual partners, females and testing extragenital specimens, screening for HIV, compliance to follow-up visits, access to nucleic acid amplification tests, and receiving questionable or even obsolete antimicrobial treatment. Therefore, more accurate and comprehensive management of gonorrhea is urgently needed in Ukraine.

Risk Factors for Patients with Gonococcal Urethritis at Dr. Hasan Sadikin General Hospital Bandung, Indonesia in 2013–2019

“…In this study, there are fewer MSM compared to heterosexual men, similar to the study from Ukraine. 13 This small number of cases of gonococcal urethritis in the MSM group could be caused by the location of gonorrhea infection which tends to be extragenital organs, as in a study in Lisbon which showed that of all gonorrhea diagnoses in the reported MSM group, the majority of cases occurred in extragenital organs, with the highest proportion at anorectal sites. 18 Nearly one-fifth of the patients in this study had used illicit drugs.…”

“…In this study, most of the patients were unmarried, consistent with research conducted in Ukraine and Ghana. 7,13 The incidence of gonorrhea in unmarried men is higher than in married men. This reflects riskier sexual behavior in unmarried men, such as changing sexual partners.…”

Characteristics and Management of Gonorrhea : A Ten Years Systematic Review

“…Boiko, I et al (2020) 7 showed the management of N. gonorrhoeae infection in Ukraine are the low level of examined females, asymptomatic infection in patients and sexual partners; disregarded testing of extragenital specimens, using of conventional laboratory tests (microscopy and culture) for screening and diagnostics of gonorrhea; deficient access to nucleic acid amplification tests in the public leading specialised STI clinics in Ukraine, low level of screening for HIV; low compliance of the follow-up visits; receiving questionable or even obsolete antimicrobial treatment. It is also supposed by our data that gonococcal infection is stigmatised.…”

Temporal shifts in 24 notifiable infectious diseases in China before and during the COVID-19 pandemic

“…Interestingly, the gonorrhea incidence increased during 2021 (Fig. 4K ), potentially due to its short incubation period 28 , which resulted in quick responses to PHSMs. In contrast, for diseases such as AIDS, syphilis, hepatitis C, and hepatitis B, which typically exhibit longer incubation periods (over a month) 29 , a substantial delay between symptom onset and reporting may occur.…”