Objectives: The objectives of this study were to assess the prevalence of ciprofloxacin resistant gonorrhoea in two South African cities and to investigate the association between the isolation of ciprofloxacin resistant Neisseria gonorrhoeae and patients' HIV serostatus.
Methods: Gonococci were cultured from endourethral swabs taken from consecutive men with urethritis attending clinics in Johannesburg and Cape Town. Minimum inhibitory concentrations (MICs) for ciprofloxacin and ceftriaxone were determined with E-tests. Isolates with a ciprofloxacin MIC of ≥ 1mg/L were defined as resistant and isolates with a ceftriaxone MIC ≤ 0.25 mg/L were defined as susceptible. Rapid tests were used to screen and confirm the presence of HIV antibodies. Survey data from 2004 were used as a baseline to assess trends in gonococcal resistance to ciprofloxacin.
Results: In 2004, the prevalence of ciprofloxacin resistance was 7% in Cape Town and 11% in Johannesburg. In 2007, 37/139 (27%) Cape Town isolates and 47/149 (32%) Johannesburg isolates were resistant to ciprofloxacin; in comparison with 2004 data, this represents 2.9 fold and 1.9 fold increases respectively. All isolates were fully susceptible to ceftriaxone. There was a significant association between HIV seropositivity and the presence of ciprofloxacin resistant gonorrhoea among the patients (p = 0.034).
Conclusions: Johannesburg and Cape Town have witnessed significant rises in the prevalence of ciprofloxacin resistant gonorrhoea among men with urethritis. The resistant phenotype is linked to HIV seropositivity. There is now an urgent need to change national first-line therapy for presumptive gonococcal infections within South Africa.