A systematic review of antimicrobial resistance in Neisseria gonorrhoeae and Mycoplasma genitalium in sub-Saharan Africa

Abstract

Objectives Limited antimicrobial resistance (AMR) surveillance coupled with syndromic management of sexually transmitted infections (STIs) in sub-Saharan Africa (SSA) could be contributing to an increase in AMR in the region. This systematic review aimed to synthesize data on the prevalence of AMR in common STIs in SSA and identify some research gaps that exist. Methods We searched three electronic databases for studies published between 1 January 2000 and 26 May 2020. We screened the titles and abstracts for studies that potentially contained data on AMR in SSA. Then we reviewed the full text of these studies to identify articles that reported data on the prevalence of AMR in Neisseria gonorrhoeae, Chlamydia trachomatis, Trichomonas vaginalis and Mycoplasma genitalium in SSA. We summarized the data using a narrative synthesis. Results The 40 included studies reported on AMR data from 7961 N. gonorrhoeae isolates from 15 countries in SSA and 350 M. genitalium specimens from South Africa. All four SSA regions reported very high rates of ciprofloxacin, tetracycline and penicillin resistance in N. gonorrhoeae. Resistance to cefixime or ceftriaxone was observed in all regions except West Africa. Azithromycin resistance, recommended as part of dual therapy with an extended-spectrum cephalosporin for gonorrhoea, was reported in all the regions. Both macrolide and fluoroquinolone-associated resistance were reported in M. genitalium in South Africa. Studies investigating AMR in C. trachomatis and T. vaginalis were not identified. Conclusions There is a need to strengthen AMR surveillance in SSA for prompt investigation and notification of drug resistance in STIs.

Mycoplasma genitalium and Antimicrobial Resistance Among a Cohort of West African Men Who Have Sex With Men Using Preexposure Prophylaxis (CohMSM-PrEP ANRS 12369-Expertise France Study)

“…Besides the high prevalence of MG, we also report on the presence of RAMs to macrolides and fluoroquinolones in MG among African MSM, which was previously mostly documented in high-resource settings [ 11 , 14 ]. The results found in our study population were different compared to MSM in high-resource settings.…”

“…Although MG resistance is frequently investigated in high-resource settings, data from the African region are scarce and mostly focus on women [ 14 ]. Studies from South Africa showed that the presence of RAMs to macrolides is rare to nonexistent, but RAMs to fluoroquinolones were more frequently detected [ 15–18 ].…”

Prevalence of five curable sexually transmitted infections among women in Lower River Region of The Gambia

“…We found serovars D and G in this sample set, which were the two most common CT serovars in a 2012 study from nearby Guinea Bissau. (41) The low NG prevalence is reassuring, given NG's propensity to develop extensive drug resistance (42,43) resulting in it being on WHO's "high priority" list for new antibiotics. (44) MG is another pathogen where AMR is of increasing concern.…”

“…(44) MG is another pathogen where AMR is of increasing concern. (43,44) However, in a systematic review of mutations associated with macrolide and uoroquinolone resistance in MG, AMR data for the African region were only available from Kenya and South Africa. (45) Integrating AMR surveillance with prevalence and incidence monitoring would be valuable in this setting, particularly considering the amount of community-wide exposure to antimicrobials imparted by neglected disease mass drug administration campaigns in The Gambia and its neighbouring countries.…”

Challenges in Clinical Diagnosis and Management of Chronic Endometritis

“…Antibiotic resistance is unexceptionally increasing in the field of obstetrics and gynecology. This includes drug-resistant Neisseria gonorrhea , Candida species, Mycoplasma genitalium , group B Streptococcus , and some Escherichia Coli isolates (ST131) [ 84 , 85 , 86 , 87 ]. Multiple antibiotic agents such as penicillin, cephalosporins, macrolides, fluoroquinolones, and trimethoprim/sulfamethoxazole are ineffective against these pathogens.…”