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Following the collapse of the Soviet Union, the management of sexually transmitted infections (STIs) became fragmented, with a consequent increase in STI morbidity. In Belarus, reliable data are generally lacking as a result of poor access to effective diagnostic facilities, while the quality of laboratory testing for STIs in recognised centres is questionable. As part of the Belarusian-Swedish project "Optimization of the prevention and control of STI/HIV in Belarus" (1) we surveyed STI diagnostic facilities for the methods they used (including their range, availability and quality) and their adherence to international evidence-based guidelines. MATERIALS AND METHODSDuring the period September 2006 to December 2007, all state-owned laboratories and other facilities that performed laboratory diagnostics for STIs in Belarus were invited to complete a questionnaire similar to that used and validated in our earlier studies (2). To evaluate the quality of the diagnostic assays and algorithms/strategies used in the surveyed laboratories, international evidence-based recommendations for STI diagnostics and definitions of STI surveillance cases (3-5) were used for comparison. RESULTSOf the 316 state medical facilities that provided STI services, 44% performed testing for syphilis, 82% for gonorrhoea, 80% for trichomoniasis, 55% for genital chlamydial infections, 24% for genital Ureaplasma and Mycoplasma infections, 51% for Candida infections, 61% for bacterial vaginosis (BV), 16% for genital herpes, and 4% for human papillomavirus. On average, each laboratory provided STI diagnostic services for approximately 30,000 inhabitants.Screening for syphilis was performed in 140 of the 316 laboratories surveyed (44%). Of these, 130 (93%) used locally-manufactured microprecipitation reaction (MPR) tests employing cardiolipin antigen and treponemal enzyme-linked immunoassays (ELISAs). Confirmatory treponemal ELISAs were used in only 56% of these laboratories. The Treponema pallidum haemagglutination (TPHA) test was used by 1.3% of the laboratories, while fluorescent treponemal antibody absorbed (FTA-abs) and T. pallidum immobilisation (TPI) tests were performed at seven (5%) central regional serology laboratories. Thirteen percent of the laboratories performed dark-field microscopy for the direct detection of T. pallidum.More than 80% of the surveyed laboratories tested for Neisseria gonorrhoeae and Trichomonas vaginalis infections. Microscopic analysis of méthylène blueand/or Gram-stained smears was the main diagnostic method employed for the diagnosis and screening of both males and females (used by 76% of laboratories). Culture for N. gonorrhoeae was performed in 54 laboratories (17%). Persons suspected of having gonorrhoea, sexual contacts of persons with diagnosed gonorrhoea, and persons being tested to determine whether or not they had been cured were extensively exposed to provocation methods (biological, chemical, mechanical, alimentary and physiological) before culture was performed (6). Only five laboratories (1.6%) uti...

Background Limited antimicrobial resistance (AMR) data for Neisseria gonorrhoeae are available in Eastern Europe. We investigated AMR in N. gonorrhoeae isolates in the Republic of Belarus from 2009 to 2019, antimicrobial treatment recommended nationally, and treatment given to patients with gonorrhoea. Methods N. gonorrhoeae isolates (n = 522) cultured in three regions of Belarus in 2009–2019 were examined. Determination of minimum inhibitory concentrations (MICs) of eight antimicrobials was performed using Etest. Resistance breakpoints from the European Committee on Antimicrobial Susceptibility Testing were applied where available. A Nitrocefin test identified β-lactamase production. Gonorrhoea treatment for 1652 patients was also analysed. Statistical significance was determined by the Z-test, Fisher’s exact test, or Mann-Whitney U test with p-values of < 0.05 indicating significance. Results In total, 27.8% of the N. gonorrhoeae isolates were resistant to tetracycline, 24.7% to ciprofloxacin, 7.0% to benzylpenicillin, 2.7% to cefixime, and 0.8% to azithromycin. No isolates were resistant to ceftriaxone, spectinomycin, or gentamicin. However, 14 (2.7%) isolates had a ceftriaxone MIC of 0.125 mg/L, exactly at the resistance breakpoint (MIC > 0.125 mg/L). Only one (0.2%) isolate, from 2013, produced β-lactamase. From 2009 to 2019, the levels of resistance to ciprofloxacin and tetracycline were relatively high and stable. Resistance to cefixime was not identified before 2013 but peaked at 22.2% in 2017. Only sporadic isolates with resistance to azithromycin were found in 2009 (n = 1), 2012 (n = 1), and 2018–2019 (n = 2). Overall, 862 (52.2%) patients received first-line treatment according to national guidelines (ceftriaxone 1 g). However, 154 (9.3%) patients received a nationally recommended alternative treatment (cefixime 400 mg or ofloxacin 400 mg), and 636 (38.5%) were given non-recommended treatment. Conclusions The gonococcal resistance to ciprofloxacin and tetracycline was high, however, the resistance to azithromycin was low and no resistance to ceftriaxone was identified. Ceftriaxone 1 g can continuously be recommended as empiric first-line gonorrhoea therapy in Belarus. Fluoroquinolones should not be prescribed for treatment if susceptibility has not been confirmed by testing. Timely updating and high compliance with national evidence-based gonorrhoea treatment guidelines based on quality-assured AMR data are imperative. The need for continued, improved and enhanced surveillance of gonococcal AMR in Belarus is evident.

Background: Increasing antimicrobial resistance (AMR) in Neisseria gonorrhoeae , including to first-line treatment options, is a great concern worldwide. However, very limited gonococcal AMR data are available in Eastern Europe. We investigated the AMR in N. gonorrhoeae isolates (n=522) cultured in three regions of the Republic of Belarus, 2009-2019, antimicrobial treatment recommended nationally, and treatment given to 1652 gonorrhoea patients in two of the regions (Minsk, 2013-2018; Mogilev, 2010-2019). Methods: Determination of minimum inhibitory concentrations (MICs) of eight antimicrobials was performed using Etest and, where available, resistance breakpoints from the European Committee on Antimicrobial Susceptibility Testing were applied. β-lactamase production was examined using a Nitrocefin test. Gonorrhoea treatment was analysed from medical records. Results: In total, 27.8% of isolates were resistant to tetracycline, 24.7% to ciprofloxacin, 7.0% to benzylpenicillin, 2.7% to cefixime, and 0.8% to azithromycin. No isolates were resistant to ceftriaxone, spectinomycin, or gentamicin. However, four (0.8%) isolates had a ceftriaxone MIC of 0.125 mg/L, which is exactly at the resistance breakpoint (MIC>0.125 mg/L). Only one (0.2%) isolate, from 2013, produced β-lactamase. From 2009-2019, the levels of resistance to ciprofloxacin and tetracycline were relatively stably high. Resistance to cefixime was not identified before 2013, but peaked at 22.2% in 2017. Only sporadic isolates with resistance to azithromycin were found in 2009 (n=1), 2012 (n=1) and 2018-2019 (n=2). Overall, 862 (52.2%) patients received first-line treatment in accordance with national guidelines (ceftriaxone 1 g). However, 154 (9.3%) patients received a nationally recommended alternative treatment (cefixime 400 mg or ofloxacin 400 mg), and 636 (38.5%) patients were given treatment non-compliant to the Belarusian national gonorrhoea guideline. Conclusions: Ceftriaxone 1 g, in combination with azithromycin 2 g particularly when chlamydial infection has not been excluded, should be recommended as empiric first-line treatment. Spectinomycin 2 g, where available, together with azithromycin 2 g could be an alternative treatment. When susceptibility has not been confirmed by testing, fluoroquinolones should not be used for treatment. Timely updating of and high compliance to national evidence-based gonorrhoea treatment guidelines that are based on quality-assured AMR data is imperative. Continued and expanded gonococcal AMR surveillance in Belarus is crucial.

This paper reports survey-based data on the diagnosis and management of genital herpes simplex virus (HSV) infection in 14 countries of the Eastern European Network for Sexual and Reproductive Health (EE SRH). Only 43% of the countries could provide the number of genital HSV cases recorded at national level. Eighty-six percent of countries employed syndromic management in cases of genital ulcer disease. Most countries performed type-specific and/or non-type-specific enzyme immunoassays to detect HSV antibodies. Non-type-specific serology for diagnostic purposes should be actively discouraged. Direct detection methods for HSV, such as PCR, antigen detection and culture, are available in the region, but their usage was extremely low. Their use in Eastern European countries should be actively promoted. The availability of laboratory services must be improved, and countries in the region should implement consensus recommendations for the laboratory diagnosis of genital HSV infections in order to improve clinical practice.