Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Jun 10;6(2):e17009.
doi: 10.2196/17009.

Antimicrobial Resistance of Neisseria Gonorrhoeae in a Newly Implemented Surveillance Program in Uganda: Surveillance Report

Meklit Workneh #  1 , Matthew M Hamill #  1 , Francis Kakooza  2 , Emmanuel Mande  2 , Jessica Wagner  3 , Olive Mbabazi  2 , Rodney Mugasha  2 , Henry Kajumbula  2 , Richard Walwema  2 , Jonathan Zenilman  1 , Patrick Musinguzi  4 , Peter Kyambadde  4 , Mohammed Lamorde  2 , Yukari C Manabe  1   2
Affiliations

Antimicrobial Resistance of Neisseria Gonorrhoeae in a Newly Implemented Surveillance Program in Uganda: Surveillance Report

Meklit Workneh et al. JMIR Public Health Surveill. .

Abstract

Background: Neisseria gonorrhoeae (commonly known as gonorrhea) has developed resistance to all first-line therapy in Southeast Asia. East Africa has historically had absent or rudimentary gonorrhea surveillance programs and, while the existence of antimicrobial-resistant gonorrhea is recognized, the extent of its resistance is largely unknown. In 2016, the World Health Organization's Enhanced Gonococcal Antimicrobial Surveillance Program (EGASP) was initiated in Uganda to monitor resistance trends.

Objective: This study characterizes gonorrhea and antibiotic resistance in a large surveillance program of men with urethral discharge syndrome from Kampala, Uganda.

Methods: Men attending sentinel clinics with urethritis provided demographic information, behavior data, and a urethral swab in line with the World Health Organization's EGASP protocols for culture, identification, and antibiotic-sensitivity testing using 2 methods-disk diffusion (Kirby-Bauer test) and Etest (BioMérieux Inc). A subset of samples underwent detailed antimicrobial resistance testing.

Results: Of 639 samples collected from September 2016 to February 2018, 400 (62.6%) were culture-positive though 414 (64.8%) had microscopic evidence of gonorrhea. The mean age of the men from whom the samples were collected was 26.9 (SD 9.6) years and 7.2% (46/639) reported having HIV. There was high-level resistance to ciprofloxacin, tetracycline, and penicillin (greater than 90%) by Kirby-Bauer disk diffusion and 2.1% (4/188) had reduced azithromycin sensitivity by Etest. Of the early isolates that underwent detailed characterization, 60.3% (70/116) were culture-positive, 94% (66/69) isolates were either ciprofloxacin-resistant or ciprofloxacin-intermediate by Etest, 96% (65/68) were azithromycin-sensitive, and 96% (66/69) were gentamicin-sensitive. Resistance profiles were comparable between methods except for ceftriaxone (disk diffusion: 68/69, 99%; Etest: 67/69, 97%) and for gentamicin (disk diffusion: 2/8, 25%; Etest: 66/69, 96%) sensitivity.

Conclusions: This is the first report from a systematic gonorrhea surveillance program in Uganda. Findings demonstrated resistance or increased minimum inhibitory concentration to all key antigonococcal antibiotics. There was evidence of poor antibiotic stewardship, near-universal resistance to several antibiotics, and emerging resistance to others. Individuals in the population sampled were at exceptionally high risk of STI and HIV infection requiring intervention. Ongoing surveillance efforts to develop interventions to curtail antimicrobial-resistant gonorrhea are needed.

Keywords: Neisseria Gonorrhoeae; STD; STI; Uganda; antibiotic resistance, EGASP; antimicrobial resistance; gonorrhea; sexually transmitted; surveillance.

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest: None declared.

References

    1. Hook EW, Handsfield HH. Gonococcal infections in the adult. In: Holmes KK, Sparling PF, Stamm WE, Piot P, Wasserheit JN, Corey L, Cohen MS, Watts DH, editors. Sexually Transmitted Diseases. 4th ed. New York: McGraw-Hill Education; 2007. pp. 627–645.
    1. Fleming DT, Wasserheit JN. From epidemiological synergy to public health policy and practice: the contribution of other sexually transmitted diseases to sexual transmission of HIV infection. Sex Transm Infect. 1999 Feb 01;75(1):3–17. doi: 10.1136/sti.75.1.3. http://sti.bmj.com/cgi/pmidlookup?view=long&pmid=10448335 - DOI - PMC - PubMed
    1. Rowley J, Vander Hoorn Stephen, Korenromp E, Low Nicola, Unemo Magnus, Abu-Raddad Laith J, Chico R Matthew, Smolak Alex, Newman Lori, Gottlieb Sami, Thwin Soe Soe, Broutet Nathalie, Taylor Melanie M. Chlamydia, gonorrhoea, trichomoniasis and syphilis: global prevalence and incidence estimates, 2016. Bull World Health Organ. 2019 Aug 01;97(8):548–562P. doi: 10.2471/BLT.18.228486. http://europepmc.org/abstract/MED/31384073 - DOI - PMC - PubMed
    1. Newman L, Rowley J, Vander Hoorn S, Wijesooriya NS, Unemo M, Low N, Stevens G, Gottlieb S, Kiarie J, Temmerman M. Global estimates of the prevalence and incidence of four curable sexually transmitted infections in 2012 based on systematic review and global reporting. PLoS One. 2015;10(12):e0143304. doi: 10.1371/journal.pone.0143304. http://dx.plos.org/10.1371/journal.pone.0143304 - DOI - DOI - PMC - PubMed
    1. Unemo M, Shafer WM. Antimicrobial resistance in Neisseria gonorrhoeae in the 21st century: past, evolution, and future. Clin Microbiol Rev. 2014 Jul;27(3):587–613. doi: 10.1128/CMR.00010-14. http://cmr.asm.org/cgi/pmidlookup?view=long&pmid=24982323 - DOI - PMC - PubMed

Publication types

MeSH terms