Background GC constitutes the second most commonly reportable disease in the United States with over 320,000 cases annually. With the emergence of drug-resistant GC in the past 40 years, treatment options have become very limited. Hence, the U.S. Department of Defense has launched a GC resistance surveillance network in 8 countries; preliminary results are reported from the United States, Djibouti, Ghana, Kenya, and Peru.
Methods Patients with urethritis, cervicitis or vaginitis symptoms were recruited at participating clinics serving military personnel and beneficiaries, civilians, and at-risk groups of men who have sex with men and female commercial sex workers. Urethral swabs were collected from men; urethral or vaginal swabs from women; diagnosis was done using culture identification, nucleic acid amplification testing, and real-time PCR. Antimicrobial susceptibility testing (AST) was conducted on GC positive isolates using real-time PCR, disc diffusion, and E-test strip methods.
Results Overall, 108 (6%) of 1,694 enrolled subjects tested positive for GC. Prevalence was found to be highest in Kenya where 33 (38%) of 86 patients were positive and was lowest in Peru where only 30 (2%) of 1,296 patients were positive. AST results were available on 66 GC positives; resistance to at least three antibiotics was observed across all overseas sites. Greatest variability in resistance was noted in Djibouti as follows: penicillin (100%), tetracycline (88%), ciprofloxacin (38%), levofloxacin (17%), cefepime (13%), and ceftriaxone (13%). High-level resistance (100%) was also noted in Ghana to ciprofloxacin, penicillin, and tetracycline.
Conclusion These findings provide evidence of emerging drug-resistant GC in several regions of the world; the resistance found against third-generation cephalosporin in Djibouti is especially noteworthy. With continuing global vigilance, GC drug resistance information will provide an important basis for the development of effective control measures, particularly among deployable forces and at-risk populations in geographical regions of military relevance.
- Antimicrobial Resistance
- Surveillance Network