Background Neisseria gonorrhoeae drug resistance has emerged worldwide. There is limited data about the situation in South Africa where syndromic management is used for sexually transmitted infections (STIs). We investigated the antimicrobial resistance profile of Neisseria gonorrhoeae infections in high-risk men.
Methods We conducted a cross-sectional study at three primary healthcare facilities in Johannesburg, South Africa. We recruited: (a) men with persistent or recurrent discharge following recent treatment, and b) men-who-have sex with men (MSM) presenting with urethral discharge. Urethral swab and urine were obtained for culture of Neisseria gonorrhoeae on New York city medium followed by drug susceptibility testing using E-test with minimum inhibitory concentration (MIC) as per EUCAST guidelines. Molecular diagnostics for STIs were performed using the TIB MOLBIOL Lightmix Kit 480 HT CT/NG assay and real-time PCR assays for Trichomonas vaginalis and Mycoplasma genitalium.
Results We recruited 48 men of which 30 (63%) had persistent or recurrent discharge and 18 (37%) were MSM. Urine PCR was positive for Neisseria gonorrhoeae in 36 men (75%); Chlamydia trachomatis was detected in 9 (19%), Mycoplasma genitalium in 13 (27%) and Trichomonas vaginalis in 6 (13%). Gonococcal cultures were positive for 25/36 men (69%) with Neisseria gonorrhoeae detected molecularly. Isolates showed resistance to ciprofloxacin in 60%, penicillin 32% and tetracycline 60%. Reduced susceptibility to azithromycin was identified in 11/25 (44%) isolates: 5 were resistant (MIC range 1–8 µg/ml) and another 6 showed intermediate resistance. All MIC values for the cephalosporins and spectinomycin were within the susceptible range.
Conclusion The observed high rate of azithromycin resistance in Neisseria gonorrhoeae infection in our high-risk population is of great concern as it effectively results in monotherapy. These findings add to the debate on the best regimen choice for syndromic management, and emphasize that the introduction of diagnostics is a priority in our setting.
Disclosure No significant relationships.
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