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Original research
Implementation of a standardised and quality-assured enhanced gonococcal antimicrobial surveillance programme in accordance with WHO protocols in Kampala, Uganda
  1. Francis Kakooza1,2,
  2. Patrick Musinguzi3,
  3. Meklit Workneh4,
  4. Richard Walwema1,
  5. Peter Kyambadde3,
  6. Emmanuel Mande1,
  7. Christopher Lubega1,
  8. Jhamira M Nakasi1,
  9. Reuben Kiggundu1,
  10. Matthew M Hamill4,
  11. Bernard S Bagaya2,
  12. Mohammed Lamorde1,
  13. Magnus Unemo5,
  14. Yukari C Manabe1,4
  1. 1 Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
  2. 2 Department of Immunology and Molecular Biology, Makerere University College of Health Sciences, Kampala, Uganda
  3. 3 Ministry of Health, National Sexually Transmitted Infections Control Program, Kampala, Uganda
  4. 4 Division of Infectious Diseases, Johns Hopkins University, School of Medicine, Baltimore, Maryland, USA
  5. 5 WHO Collaborating Centre for Gonorrhoea and Other STIs, National Reference Laboratory for Pathogenic Neisseria, Department of Laboratory Medicine Clinic of Microbiology, Faculty of Medicine and Health, Örebro University, Orebro, Sweden
  1. Correspondence to Francis Kakooza, Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda; fkakooza{at}


Objectives The emergence of multidrug-resistant Neisseria gonorrhoeae (NG) is a major global health threat necessitating response and control measures. NG antimicrobial resistance (AMR) surveillance data from sub-Saharan countries is exceedingly limited. This paper aims to describe the establishment, design and implementation of a standardised and quality-assured gonococcal surveillance programme and to describe the susceptibility patterns of the cultured gonococcal isolates in Kampala, Uganda.

Methods From March 2018 to September 2019, using the WHO Enhanced Gonococcal Antimicrobial Surveillance Programme (EGASP) protocol, consecutive males with urethral discharge syndrome were recruited from 10 surveillance sites in Kampala City, Uganda, in collaboration with the Ministry of Health. Males completed a questionnaire and provided a urethral swab specimen. Culture, identification and antimicrobial susceptibility testing (Etest) were performed.

Results Of the 1013 males recruited, 73.1% (740/1013) had a positive Gram stain and 51.1% (n=518) were culture-positive for NG. Using Etest (458 isolates), the resistance to ciprofloxacin was 99.6%. Most isolates were susceptible to azithromycin, cefoxitin and gentamicin, that is, 99.8%, 98.5% and 92.4%, respectively, and all isolates were susceptible to ceftriaxone and cefixime.

Conclusions We established a standardised, quality-assured WHO EGASP. Using Etest, 458 isolates were characterised, with associated epidemiological surveillance data, in 1.5 years, which by far exceed the minimum 100 isolates per year and country requested in the WHO Global GASP, to detect AMR levels with confidence. These isolates with the epidemiological data can be used to develop population level interventions.

  • antimicrobial resistance
  • gonorrhoea
  • azithromycin
  • epidemiology (general)

Data availability statement

Data are available on reasonable request.

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Data availability statement

Data are available on reasonable request.

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  • MU and YCM are joint senior authors.

  • Handling editor Bea Vuylsteke

  • Twitter @franciskakooza1

  • Contributors FK led the coordination of the surveillance programme and wrote the manuscript with support by BSB, MMH, ML, RK and MU. MW, YCM, ML and RW provided the strategic direction; PM and PK spearheaded the collaborative efforts from Ministry of Health; EM, CL and JMN supported the laboratory data management. All authors reviewed the final manuscript.

  • Funding The funding was from Global Health Security Partner Engagement Project 1U2GGH001744-01 through US CDC.

  • Competing interests None declared.

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