Introduction In Indonesia, syndromic management is used for diagnosis and treatment of sexually transmitted infections (STIs), but this approach does not provide accurate data to assess the epidemiology of gonorrhoea and antimicrobial susceptibility of circulating Neisseria gonorrhoeae strains. We studied gonorrhoea prevalence and antimicrobial resistance of N. gonorrhoeae among patients of STI clinics in 3 large cities in Indonesia.

Methods In 2014, urogenital swabs were obtained from sexually active adults, mainly female sex workers, men who have sex with men, and male-to-female transgenders attending STI clinics in Jakarta, Yogyakarta, and Denpasar. In some patients additional rectal and pharyngeal swabs were taken. Diagnosis of N. gonorrhoeae infection was established by real time PCR targeting Opa genes. Culture isolates of N. gonorrhoeae were tested for antimicrobial susceptibility against doxycyclin, ciprofloxacin, azithromycin, ceftriaxone and cefixime by E-test™ using EUCAST breakpoints.

Results We included 764 participants: 346 (45.3%) males, 321 (42.0%) females and 97 (12.7%) transgenders (median ages 27, 30, and 38 years). In total, 800 samples were collected: 443 urethral, 321 cervical, 23 rectal, and 13 pharyngeal swabs. In 215 (28.1%) participants N. gonorrhoeae infection was detected by PCR. Prevalence varied significantly by gender (26.0% in males, 32.1% in females, and 22.7% in transgenders, p = 0.04); and varied significantly by city: 14.5% in Denpasar, 31.5% in Jakarta and 27.5% in Yogyakarta (p = 0.015).

Of 77 isolates tested for antimicrobial susceptibility, all were sensitive to azithromycin, ceftriaxone, and cefixime. In contrast, resistance to doxycyclin (98.7%) and ciprofloxacin (100%) was very common.

Conclusion This is the first study since 2004 describing the epidemiology of gonorrhoea and antimicrobial resistant strains in Indonesia. Prevalence of gonorrhoea is very high among STI clinic visitors. In view of the extensive resistance against doxycyclin and ciprofloxacin, these antibiotics are not appropriate treatment options for gonorrhoea; instead, extended spectrum cephalosporins are advised.

Disclosure of interest statement The study is funded by Indonesian government through Beasiswa Unggulan (The Excellence Scholarship Program), Ministry of Education and Culture Republic of Indonesia and Public Health Service (GGD) of Amsterdam, The Netherlands. The authors declare that there is no conflict of interest.