Introduction There is increasing urgency to document changing antimicrobial resistance (AMR) patterns of N. gonorrhoea (GC) in different parts of the world. High-level resistance to previously recommended quinolones is widespread and decreased susceptibility to the extended-spectrum (third-generation) cephalosporin. The surveillance for AMR in Kenya and the region was undertaken to determine the frequency and diversity of antimicrobial resistance of gonococcal isolates from Sex Workers Outreach Program (SWOP) Clinic.

Methods The survey tested 238 isolates over a period of 4 years 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 and identified by standard bacteriological procedures. Antibiotic susceptibility testing of GC isolates was performed using diffusion gradient method. The MICs of penicillin, tetracycline, ciprofloxacin, spectinomycin, erythromycin, Azithromycin, cefixime and ceftriaxone were determined by the E-test method. The strains were defined as susceptible, intermediate and resistant using the WHO guidelines, all the findings were validates at WHO Collaborating Centre for Gonorrhoea and other STIs, Örebro University Hospital in Sweden.

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

Conclusion Spectinomycin, cefixime, ceftriaxone, azithromycin are useful. Ciprofloxacin the most prescribed antibiotic is no longer reliable for treatment of GC. Continuous surveillance is essetial to mordify treatmet guidelies. Worsening GC drug resistance will compromise effective treatment and decrease disease control efforts.