Background The incidence of gonococcal infections in Estonia peaked in 1993 with an infection rate of 233 cases/100,000 population and declined to 16.2 cases/100,000 population in 2012. The greatest part of clinical laboratories desists from N. gonorrhoeae cultivation. 100% of Neisseria gonorrhoeae diagnosis in Estonia is made by DNA detection techniques. Different tests are in use: Rapid DNA probe GEN-PROBE PACE (Gen-Probe Incorporated San Diego. USA), PCR with in house made primers other commercially available STI tests.

Aims to improve laboratory diagnosis of gonorrhoe and monitoring of antimicrobial susceptibilities of N gonorrhoeae to investigate treatment failure and to evaluate the efficacy of currently recommended therapies.

Methods In 2007, Estonian IUSTI branch has elaborated National Guidelines for the STI management (on the base of the European STD Guidelines and Eastern European Network for Sexual and Reproductive Health) with it’s second revission in 2011. For N.gonorrhoeae diagnosis was recommended to start with molecular test and then if positive to continue with cultural method, using disc diffusion method and E-tests for AMR. WHO reference panel N.gonorrhoeae was obtained from reference laboratory in Örebro, Sweden.

Results Totally 24 isolates obtained. Gonococci (14) were collected from urethral swabs of men, 8 strains were isolated from female cervical swabs, gender was unknown for 2 cases (anonymous). AMR detected in 4 isolates; 2 were strains isolated after treatment failure: one - resistant to Pen, Tetra, Cipro and susceptible to Ceftriaxone; second - resistant to Pen, Tetra, Cipro and had decreased susceptibility (resistance) to Ceftriaxone (MIC 0.25mg/L). In addition in 2 isolates MICs to Ceftriaxone were 0.38mg/L and 0.50 mg/L. AMR were detected to penicillin (12.5%), to ciprofloxacin (8.4%) and to tetracycline (8.4%).

Conclusion Gonorrhoea may become untreatable under certain circumstances and surveillance of N. gonorrhoeae AMR is crucial in Estonia.