High Prevalence of Drug Resistant Neisseria Gonorrhoeae in Males With Urethral Discharge at the STD Clinic Mulago Hospital Uganda

Abstract

Among the treatable sexually transmitted infections (STIs), Neisseria gonorrhoeae is considered to be most important because of its ever evolving antibiotic resistance. Currently third generation cephalosporins are recommended as first-line drugs in many countries. Unfortunately, resistance to these cephalosporins (cefixime and ceftriaxone) has been reported elsewhere. The objectives of the study were to determine the prevalence of Neisseria gonorrhoea in adult males presenting to Mulago hospital with urethral discharge and to determine the level of resistance of Neisseria gonorrhea to the commonly available antimicrobial agents at the clinic focusing on extended-spectrum cephalosporins. In a cross sectional study, we enrolled 112 adult males aged 18-65 yrs with urethral discharge at the STD clinic Mulago Hospital. Prevalence of gonorrhoea was determined based on Gram staining and/or N. gonorrhea isolation at culture. Antimicrobial susceptibility testing was determined with the Kirby-Bauer disk diffusion method and with the Nitrocefin tests for β-lactamase production. Among 112 adult male patients aged 18-65 years with urethral discharge,the prevalence of N. gonorrhea was at 81.3%. Resistance to drugs was identified at the following rates: tetracycline 100%, ciprofloxacin 94.8%, cotrimoxazole 91.4%, penicillin 82.8%, cefixime 20.7%, ceftriaxone 5.2%, spectinomycin 1.7%, and azithromycin 0%. According to this study drug resistance to commonly available antimicrobials for N. gonorrhea is very high among isolates from patients attending the STI clinic, Mulago Hospital Kampala, Uganda. Ceftriaxone, spectinomycin and azithromycin appeared to be the most useful drugs in the treatment of N. gonorrhea infection at the clinic. This work was completed in November 2017.