Antimicrobial susceptibility of Neisseria gonorrhoeae isolates and syndromic treatment of men with urethral discharge in Kingston, Jamaica, 2018-19

Abstract

Objectives: To quantitatively determine the antimicrobial susceptibility of clinical Neisseria gonorrhoeae isolates from men with urethral discharge in Jamaica and to describe the syndromic treatment therapies administered.

Methods: Urethral eSwabs (Copan) were collected from 175 men presenting with urethral discharge to the Comprehensive Health Centre STI Clinic, Kingston, Jamaica. Clinical information was collected and MICs of eight antimicrobials were determined for N. gonorrhoeae isolates (n = 96) using Etest and interpreted using CLSI criteria.

Results: The median age of the subjects was 28 years (range: 18-73 years) with a median of 2 sexual partners (range: 1-25) per male in the previous 3 months. All examined N. gonorrhoeae isolates were susceptible to ceftriaxone (96/96), azithromycin (91/91), cefixime (91/91) and spectinomycin (91/91). For ciprofloxacin and gentamicin, respectively, 98.9% (91/92) and 91.3% (84/92) of the isolates were susceptible and 1.1% (1/92) and 8.7% (8/92) showed intermediate susceptibility/resistance. For tetracycline and benzylpenicillin, respectively, 38.0% (35/92) and 22.0% (20/91) of the isolates were susceptible, 52.2% (48/92) and 74.7% (68/91) showed intermediate susceptibility/resistance and 9.8% (9/92) and 3.3% (3/91) were resistant. Syndromic treatment was administered as follows: 93.1% received 250 mg of ceftriaxone intramuscularly plus 100 mg of doxycycline orally q12h for 1-2 weeks and 6.9% received 500 mg of ciprofloxacin orally plus 100 mg of doxycycline orally q12h for 1 week.

Conclusions: Ceftriaxone (250 mg) remains appropriate for gonorrhoea treatment in the examined population of men in Kingston, Jamaica. Surveillance of N. gonorrhoeae AMR should be expanded in Jamaica and other Caribbean countries to guide evidence-based treatment guidelines.

Figure 1.

MIC distributions of eight therapeutic antimicrobials for N. gonorrhoeae isolates cultured in Kingston, Jamaica, 2018–19. Breakpoints in accordance with the current CLSI guidelines (www.clsi.org) are indicated. Previously published susceptibility and resistance breakpoints were used for gentamicin. S, susceptible; I, intermediate; R, resistant. MIC₅₀ values of the eight antimicrobials were as follows: ceftriaxone, 0.002 mg/L (range: <0.002–0.016 mg/L); cefixime, <0.016 mg/L (range: <0.016–0.094 mg/L); ciprofloxacin, 0.003 mg/L (range: <0.002–0.094 mg/L); azithromycin, 0.094 mg/L (range: 0.016–0.5 mg/L); tetracycline, 0.38 mg/L (range: 0.094–48 mg/L); gentamicin, 3 mg/L (range: 1–8 mg/L); benzylpenicillin, 0.125 mg/L (range: 0.004–4 mg/L); and spectinomycin, 12 mg/L (range: 3–24 mg/L).