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 the HIV serostatus of patients.
Methods: Gonococci were cultured from endourethral swabs taken from consecutive men with urethritis attending clinics in Johannesburg and Cape Town. Minimum inhibitory concentrations (MIC) for ciprofloxacin and ceftriaxone were determined with E-tests. Isolates with a ciprofloxacin MIC of 1 mg/l or greater were defined as resistant and isolates with a ceftriaxone MIC of 0.25 mg/l or less 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 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.
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Funding: This study was supported by cooperative agreement no U62/CCU022901 from the Centers for Disease Control and Prevention (CDC), Atlanta, USA. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Department of Health and Human Services at the CDC and the National Centre for Global AIDS Prevention.
Competing interests: None.
Ethics approval: Ethics approval for the study was granted by the Human Research Ethics Committee (Medical) of the University of the Witwatersrand Ethics Committee, South Africa (protocol no M051024).
Contributors: DL, NdP, FR and EW set up the operational aspects of the study; AvZ and MS were responsible for collection of the specimens at the clinics; LS, MS and FR were responsible for laboratory testing of the gonococcal isolates and sera; SM entered the data and DL and SM undertook the data analysis. DL wrote the manuscript with contributions from all the authors.