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Antimicrobial susceptibility in Neisseria gonorrhoeae isolates from five sentinel surveillance sites in Zimbabwe, 2015–2016
  1. Ahmed S Latif1,
  2. Lovemore Gwanzura2,
  3. Anna Machiha3,
  4. Francis Ndowa3,
  5. Andrew Tarupiwa4,
  6. Muchaneta Gudza-Mugabe4,
  7. Fungai D Shukusho4,
  8. Christine Chakanyuka Musanhu5,
  9. Teodora Wi6,
  10. Magnus Unemo7
  1. 1 Public Health Consultant, Brisbane, Australia
  2. 2 Department of Medical Laboratory Sciences, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
  3. 3 STI, HIV/AIDS and TB Programmes, Ministry of Health and Child Care, Harare, Zimbabwe
  4. 4 National Microbiology Reference Laboratory, Southerton, Harare, Zimbabwe
  5. 5 World Health Organization, Country Office, Harare, Zimbabwe
  6. 6 Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
  7. 7 World Health Organization Collaborating Centre for Gonorrhoea and other STIs, Örebro University, Örebro, Sweden
  1. Correspondence to Dr Magnus Unemo, WHO Collaborating Centre for Gonorrhoea and Other STIs, National Reference Laboratory for Pathogenic Neisseria, Department of Laboratory Medicine, Microbiology, Örebro University Hospital, Örebro SE-701 85, Sweden; magnus.unemo{at}


Objectives Gonorrhoea and antimicrobial resistance (AMR) in Neisseria gonorrhoeae are major public health concerns worldwide. Enhanced AMR surveillance for gonococci is essential globally. In Zimbabwe, very limited gonococcal AMR data were reported. Our aims were to (i) implement quality-assured gonococcal AMR surveillance in Zimbabwe and (ii) investigate gonococcal AMR at five health centres in 2015–2016.

Methods Gonococcal isolates from 104 men with urethral discharge were tested for susceptibility to kanamycin, ceftriaxone, cefixime, ciprofloxacin and azithromycin using Etest.

Results All isolates (102 possible to test) were susceptible to ceftriaxone and cefixime. The level of resistance (intermediate resistance) to kanamycin and ciprofloxacin was 2.0% (2.0%) and 18.6% (27.5%), respectively. The two kanamycin-resistant isolates (R≥128 mg/L) had a kanamycin minimum inhibitory concentration (MIC) of >256 mg/L. The ciprofloxacin resistance ranged from 9.5% to 30.8% in the five sentinel sites. Only 10 (9.6%) of the isolates were tested for susceptibility to azithromycin and 1 (10.0%) was resistant (MIC=4 mg/L).

Conclusions The emergence of multidrug-resistant gonorrhoea internationally is a major public health concern and gonococcal AMR surveillance is crucial globally. In Zimbabwe, gonococcal AMR surveillance has now been implemented and quality assured according to WHO standards. The results of this first surveillance will be used to directly inform revisions of the national treatment guidelines. It is imperative to further strengthen the surveillance of gonococcal AMR, and ideally also treatment failures, in Zimbabwe and most countries in the WHO African region, which requires continuous national and international support, including technical support, and political and financial commitment.


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  • Handling editor Jackie A Cassell

  • Contributors ASL, assisted by LG, designed the surveillance protocol, performed the initial data analysis and wrote the first draft of manuscript together with MU. AM provided overall coordination during the surveillance. FN, TW and CCM provided technical support during the surveillance. AT, MG-M and FDS performed all the laboratory work. MU provided laboratory training, quality assurance and confirmatory testing. All authors contributed to the finalisation of the manuscript.

  • Funding The Department of Reproductive Health and Research, WHO, Geneva.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval The protocol and consent forms were reviewed and approved by the Medical Research Council of Zimbabwe (MRCZ; ref: MRCZ/A/1883).

  • Provenance and peer review Not commissioned; externally peer reviewed.