Neisseria gonorrhoeae among suspects of sexually transmitted infection in Gambella hospital, Ethiopia: risk factors and drug resistance

Abstract

Background: Neisseria gonorrhoeae is a bacterium responsible for one of the classic sexually transmitted infection (STI) gonorrhea. Antibiotic resistant strains are emerging at alarming rate. Multiple sexual partners, unsafe sex and substance use habits are the main host related risk factors for acquiring the infection. Thus, this study aimed at determining the magnitude, its determinants and antimicrobial resistance profile of N. gonorrhoeae in a place where there is risk related cultural practices and relatively high HIV prevalence.

Methods: A cross-sectional study was conducted on 186 STI suspected patients seen in Gambella hospital from March to July 2015. Data on socio-demographic characteristics and associated risk factors was collected using pre-designed questionnaire. Urethral or endo-cervical swabs were collected aseptically by trained nurses. Then, samples were transported to laboratory and processed within 15 min following standard microbiological culture techniques. Antimicrobial susceptibility test was performed by using Kirby-Bauer disk diffusion method. Data entry, transforming and analysis was done using SPSS version 20.

Results: In this study 11.3 % of the STI suspected patients were confirmed to have N. gonorrhoeae. The rate of infection in males was four times higher than in females accounting 16.0 and 5.0 % respectively (p = 0.049). It was also higher (18.9 %) in 20-24 years age group (p = 0.439). Alcohol intake (p = 0.013), less frequent condom use (p = 0.031), and multiple sex partners (p = 0.024) were associated with increased odds of infection. All N. gonorrhoeae isolates were susceptible to ceftriaxone and cefoxitin but all were resistant to penicillin and tetracycline. Alarmingly, 28.6 % of the isolates were resistant to ciprofloxacin.

Conclusions: The proportion of urogenital symptoms attributable to N. gonorrhoeae was high (11 %), with highest prevalence among males and young adults. Hence, prevention efforts should consider behavioral risk reduction. Ceftriaxone and cefoxitin can be considered as excellent first-line treatment options. However, alarming rate of resistance to ciprofloxacin challenges the current use of this antibiotic in the syndromic management package of gonococcal infections. Thus, laboratory based diagnosis and treatment system is need.

Fig. 1

Proportion of N. gonorrhoeae by age group and sex of STI suspected patients (n = 186) in Gambella hospital, Ethiopia, (March–July 2015)