Introduction Systematic antimicrobial resistance (AMR) surveillance of N. gonorrhoea (GC) from local to global level are being intensified to inform and design a monitoring system for its control. High-level resistance to previously recommended quinolones is widespread and decreased susceptibility to the extended-spectrum (third-generation) cephalosporin has been report. The Gonococcus antimicrobial surveillance program (GASP) in Kenya and the region carried out a study to determine the frequency and diversity of antimicrobial resistance of GC isolates from a Sex Workers Outreach Program (SWOP) Clinic in Nairobi over a period of 4 years.

Methods The study tested 238 GC isolates from participants presenting with cervical/vaginal discharge. Samples collected were inoculated directly on modified Thayer martin media (MTM), transported to GASP Laboratories at KAVI-Institute of Clinical Research for processing by standard bacteriological procedures. Antibiotic susceptibility testing was performed using diffusion gradient method. The strains were defined as susceptible, intermediate and resistant using E-test as guided by WHO, all the findings were validates at WHO Collaborating Centre for Gonorrhoea and other STIs, Örebro University Hospital in Sweden.

Results GC isolates, 41 in 2012, 119 in 2013, 24 in 2014 and 54 in 2015 showed 100% susceptibility to cefixime, ceftriaxone and spectinomycin in four years with a mean susceptibility of 82%, 37.7%, 19.5%, 1.6% and 0% for azithromycin, erythromycin, ciprofloxacin, penicillin and tetracycline respectively. Over the period ciprofloxacin showed a rise in resistance from 56% in 2012, 58.8% in 2013, 66.7% in 2014 to 68.5% in 2015.

Conclusion Spectinomycin, cefixime, ceftriaxone, azithromycin are useful drugs, while Ciprofloxacin the most prescribed antibiotic is no longer reliable for treatment of GC in the region. Continued surveillance will enables the public health managers to modify the national treatment guidelines. Worsening GC drug resistance will compromise effective treatment and decrease disease control efforts.