HIGH PREVALENCE OF DRUG RESISTANT NEISSERIA GONORRHOEAE IN MALES WITH URETHRAL DISCHARGE AT THE STD CLINIC MULAGO HOSPITAL UGANDA


HIGH PREVALENCE OF DRUG RESISTANT NEISSERIA GONORRHOEAE IN MALES WITH URETHRAL DISCHARGE AT THE STD CLINIC MULAGO HOSPITAL UGANDA


George Ndawula1*, Henry Kajumbula1, Fred Nsubuga3, Edgar Kigozi1, Freddie Bwanga1,2

1Department of Medical Microbiology Makerere University College of Health Sciences, 2MBN  Clinical Laboratories, 3Ministry of Health.


Among the treatable sexually transmitted infections (STIs), Neisseria gonorrhoeae is considered to be most important because of its ever evolving antibiotic resistance. Currently third generation cephalosporins are recommended as first-line drugs in many countries. Unfortunately, resistance to these cephalosporins (cefixime and ceftriaxone) has been reported elsewhere. The objectives of the study were to determine the prevalence of Neisseria gonorrhoea in adult males presenting to Mulago hospital with urethral discharge and to determine the level of resistance of Neisseria gonorrhea to the commonly available antimicrobial agents at the clinic focusing on extended-spectrum cephalosporins.  In a cross sectional study, we enrolled 112 adult males aged 18-65 yrs with urethral discharge at the STD clinic Mulago Hospital. Prevalence of gonorrhoea was determined based on Gram staining and/or N. gonorrhea isolation at culture. Antimicrobial susceptibility testing was determined with the Kirby-Bauer disk diffusion method and with the Nitrocefin tests for β-lactamase production.  Among 112 adult male patients aged 18-65 years with urethral discharge,the prevalence of  N. gonorrhea was  at 81.3%. Resistance to drugs was identified at the following rates: tetracycline 100%, ciprofloxacin 94.8%, cotrimoxazole 91.4%, penicillin 82.8%, cefixime 20.7%, ceftriaxone 5.2%, spectinomycin 1.7%, and azithromycin 0%. According to this study drug resistance to commonly available antimicrobials for N. gonorrhea is very high among isolates from patients attending the STI clinic, Mulago Hospital Kampala, Uganda. Ceftriaxone, spectinomycin and azithromycin appeared to be the most useful drugs in the treatment of N. gonorrhea infection at the clinic. This work was completed in November 2017.


Keywords: Antimicrobial resistance, cefixime, ceftriaxone, cephalosporins, Neisseria gonorrhea.

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How to cite this article:

George Ndawula, Henry Kajumbula, Fred Nsubuga, Edgar Kigozi, Freddie Bwanga.High Prevalence of Drug Resistant Neisseria gonorrhoeae in Males with Urethral Discharge at the STD Clinic Mulago Hospital Uganda. American Journal of Microbiology and Immunology, 2022, 7:11. DOI: 10.28933/ajmi-2021-01-0605


References

1.Todar K. Todar’s online textbook of bacteriology: University of Wisconsin-Madison Department of Bacteriology; 2006.
2. Moran JS. Gonorrhoea. Clinical evidence. 2007;2007.
3. Tapsall J, Limnios E, Murphy D. Analysis of trends in antimicrobial resistance in Neisseria gonorrhoeae isolated in Australia, 1997–2006. Journal of Antimicrobial Chemotherapy. 2008;61[1]:150-5.
4. Ghys PD, Fransen K, Diallo MO, Ettiègne-Traoré V, Coulibaly I-M, Yeboué KM, et al. The associations between cervicovaginal HIV shedding, sexually transmitted diseases and immunosuppression in female sex workers in Abidjan, Cote d’Ivoire. Aids. 1997;11[12]:F85-F93.
5. Cohen MS, Hoffman IF, Royce RA, Kazembe P, Dyer JR, Daly CC, et al. Reduction of concentration of HIV-1 in semen after treatment of urethritis: implications for prevention of sexual transmission of HIV-1. The Lancet. 1997;349[9069]:1868-73.
6. Mostad SB, Overbaugh J, DeVange DM, Welch MJ, Chohan B, Mandaliya K, et al. Hormonal contraception, vitamin A deficiency, and other risk factors for shedding of HIV-1 infected cells from the cervix and vagina. The Lancet. 1997;350[9082]:922-7.
7. Stathi M, Flemetakis A, Miriagou V, Avgerinou H, Kyriakis KP, Maniatis AN, et al. Antimicrobial susceptibility of Neisseria gonorrhoeae in Greece: data for the years 1994–2004. Journal of Antimicrobial Chemotherapy. 2006;57[4]:775-9.
8. Wang B, Xu J-s, Wang C-x, Mi Z-h, Pu Y-p, Hui M, et al. Antimicrobial susceptibility of Neisseria gonorrhoeae isolated in Jiangsu Province, China, with a focus on fluoroquinolone resistance. Journal of medical microbiology. 2006;55[9]:1251-5.
9. Enders M, Turnwald-Maschler A, Regnath T. Antimicrobial resistance of Neisseria gonorrhoeae isolates from the Stuttgart and Heidelberg areas of southern Germany. European Journal of Clinical Microbiology and Infectious Diseases. 2006;25[5]:318-22.
10. Brannigan J, Tirodimos I, Zhang QY, Dowson C, Spratt B. Insertion of an extra amino acid is the main cause of the low affinity of penicillin‐binding protein 2 in penicillin‐resistant strains of Neisseria gonorrhoeae. Molecular microbiology. 1990;4[6]:913-9.
11. Lindberg R, Fredlund H, Nicholas R, Unemo M. Neisseria gonorrhoeae isolates with reduced susceptibility to cefixime and ceftriaxone: association with genetic polymorphisms in penA, mtrR, porB1b, and ponA. Antimicrobial agents and chemotherapy. 2007;51[6]:2117-22.
12. Tanaka M, Nakayama H, Huruya K, Konomi I, Irie S, Kanayama A, et al. Analysis of mutations within multiple genes associated with resistance in a clinical isolate of< i> Neisseria gonorrhoeae</i> with reduced ceftriaxone susceptibility that shows a multidrug-resistant phenotype. International journal of antimicrobial agents. 2006;27[1]:20-6.
13. Hagman KE, Pan W, Spratt BG, Balthazar JT, Judd RC, Shafer WM. Resistance of Neisseria gonorrhoeae to antimicrobial hydrophobic agents is modulated by the mtrRCDE efflux system. Microbiology. 1995;141[3]:611-22.
14. Ameyama S, Onodera S, Takahata M, Minami S, Maki N, Endo K, et al. Mosaic-like structure of penicillin-binding protein 2 gene [penA] in clinical isolates of Neisseria gonorrhoeae with reduced susceptibility to cefixime. Antimicrobial agents and chemotherapy. 2002;46[12]:3744-9.
15. Spratt BG. Hybrid penicillin-binding proteins in penicillin-resistant strains of Neisseria gonorrhoeae. 1988.
16. Yokoi S, Deguchi T, Ozawa T, Yasuda M, Ito S-i, Kubota Y, et al. Threat to cefixime treatment for gonorrhea. Emerging infectious diseases. 2007;13[8]:1275.
17. Unemo M, Golparian D, Syversen G, Vestrheim D, Moi H. Two cases of verified clinical failures using internationally recommended first-line cefixime for gonorrhoea treatment, Norway, 2010. Microscopy. 2010;120:A121N.
18. Ison C, Hussey J, Sankar K, Evans J, Alexander S. Gonorrhoea treatment failures to cefixime and azithromycin in England, 2010. Vol 16| Weekly issue 14| 7 April 2011. 2011:7.
19. Ohnishi M, Golparian D, Shimuta K, Saika T, Hoshina S, Iwasaku K, et al. Is Neisseria gonorrhoeae initiating a future era of untreatable gonorrhea?: detailed characterization of the first strain with high-level resistance to ceftriaxone. Antimicrobial agents and chemotherapy. 2011;55[7]:3538-45.
20. Røttingen J-A, Cameron DW, Garnett GP. A systematic review of the epidemiologic interactions between classic sexually transmitted diseases and HIV: how much really is known? Sexually transmitted diseases. 2001;28[10]:579-97.
21. Unemo M, Golparian D, Stary A, Eigentler A. First Neisseria gonorrhoeae strain with resistance to cefixime causing gonorrhoea treatment failure in Austria, 2011. Euro Surveill. 2011;16[43]:pii= 19998.
22. Perilla M, Ajello G, Bopp C, Elliott J, Facklam R. Manual for the laboratory identification and antimicrobial susceptibility testing of bacterial pathogens of public health importance in the developing world. Haemophilus influenzae Neisseria meningitidis Streptococcus pneumoniae Neisseria gonorrhoeae Salmonella serotype Typhi Shigella and Vibrio cholerae. 2003.
23. Morency P, Dubois M, Gresenguet G, Frost E, Masse B, Deslandes S, et al. Aetiology of urethral discharge in Bangui, Central African Republic. Sexually transmitted infections. 2001;77[2]:125-9.
24. Rwahwir MP. Prevalence .socio-Demographic Factors and Antimicrobial Susceptibility of Neisseria gonorrhoea among men presenting with Urethral dischage at Mulago and Murchison bay Hospitals 2009.


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