Challenges in the Control of Gonorrhea in South America and the Caribbean: Monitoring the Development of Resistance to Antibiotics

Abstract

: Two countries (Argentina and Uruguay) maintained continuous surveillance during the study period. Some countries gathered data periodically and several others were unable to initiate antimicrobial surveillance as a result of lack of resources. The percentage of penicillin-resistant N. gonorrhoeae isolated in the region over the decade varied considerably (1.0-11.9% carried chromosomal resistance and 17.9-38.8% produced beta-lactamase) with an overall trend to declining numbers of penicillin-resistant isolates. For tetracycline, 7.4% to 36.3% carried chromosomal resistance, whereas 12.0% to 27.4% carried plasmid-mediated resistance. There were no reports of ciprofloxacin-resistant isolates, although N. gonorrhoeae with decreased susceptibility to ciprofloxacin and azithromycin as well as spectinomycin-resistant isolates were identified in some countries.

Antimicrobial susceptibility of Neisseria gonorrhoeae isolates from patients attending a public referral center for sexually transmitted diseases in Belo Horizonte, State of Minas Gerais, Brazil

“…The tetracycline resistance observed (32.3%) in this study is similar to that observed in Rio de Janeiro 21 (80%). These fi ndings are consistent with observations in countries such as Chile (33%) and Uruguay (32%) and lower than that obtained in Bolivia (54%), Peru (90%) and Venezuela…”

“…Specimens with resistance to penicillin and tetracycline have been reported in Brazil since 1984 18,26 . Gonorrhea has also become resistant to azithromycin (4.5%), consistent with observations in Manaus 19 (6.4%), but our reported rate is higher than the 20% intermediate sensitivity observed in Rio de Janeiro 21 . Azithromycin resistance has been reported in several countries such as Uruguay (9%), Chile (46%), Peru 23 (75%), the United States of America 3 (0.5%) and Germany 27 (7.7%).…”

“…Ciprofl oxacin resistance is greatly increased (21.4%) compared to other national studies. These studies initially observed decreased susceptibility 19,21 followed by drug resistance in Manaus 23 27 (47.7%), have detected high levels of resistance to ciprofl oxacin, and thus its use for the treatment of gonorrhea has been discontinued in these locations 4,32,33 . In addition, specimens with a high level of resistance to ciprofl oxacin (MIC>32µg/ml) that also exhibited resistance to chloramphenicol and tetracycline were identifi ed.…”

Antimicrobial Resistance in Neisseria gonorrhoeae in the 21st Century: Past, Evolution, and Future

“…Compared to erythromycin, azithromycin has a substantially higher activity against N. gonorrhoeae. However, by the mid-to late 1990s, decreased susceptibility and resistance to azithromycin were reported from Latin America, where azithromycin was frequently used early on for treatment of bacterial STIs, including gonorrhea (99,128,129). Subsequently, azithromycin resistance emerged in many countries, particularly where there was a high level of azithromycin usage for treatment of gonorrhea and also, e.g., for Chlamydia trachomatis infections (99,102,130,131).…”

Neisseria gonorrhoeae Is Evolving into a ‘Superbug’ – what Measures Can Be Implemented to Combat the Emergence of Multidrug and Extensively-drug Resistant Gonorrhoea in Latin America and Globally?

“…In LAC, a strong and quality-assured GASP was established in the 1990s (14) and there have been recent attempts to revitalize this GASP network. The connections and programmes of the GASP-LAC have been maintained in many LAC countries, and, in response to the WHO 2009 call for revitalization, the GASP--LAC regional network has been renewed (15,16) .…”