Molecular Epidemiology of Recently Emergent Ciprofloxacin-Resistant Neisseria gonorrhoeae in South Africa

Moodley, Prashini; Im, Martin; Pillay, K; Ca, Ison; Aw, Sturm

doi:10.1097/01.olq.0000194581.02022.f0

Cited by 18 publications

(14 citation statements)

References 12 publications

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“…As the microbiological proportion cured for ulcerative STIs was not available (sampling disrupts epithelialisation), they were assumed equal to the clinical proportion cured. The proportion cured for males and females with gonorrhoea was assumed to be 100% despite increasing resistance to ciprofloxacin;24 this is in line with the data suggesting that gonorrhoea remains susceptible to ceftriaxone 25. The proportion cured for chlamydial and trichomonas infection in women were assumed to be the weighted mean from the two available studies as these were not significantly different (87%, 47/54 for C trachomatis ; 87%,137/157 for T vaginalis ).…”

Section: Resultsmentioning

confidence: 82%

Low effectiveness of syndromic treatment services for curable sexually transmitted infections in rural South Africa

White

Moodley

McGrath

et al. 2008

Sexually Transmitted Infections

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Objectives:Syndromic sexually transmitted infection (STI) treatment remains a cost-saving HIV prevention intervention in many countries in Africa. We estimate the effectiveness of syndromic treatment for curable STIs in rural KwaZulu-Natal, South Africa, and the trend in STI prevalences before and after the introduction of syndromic treatment in 1995.Methods:Data were available from various clinical studies, surveys of public and private health providers, the general population and women attending antenatal, family planning and child immunisation clinics in rural northern KwaZulu-Natal between 1987 and 2004. Overall effectiveness was defined as the estimated proportion of the annual number of symptomatic curable STI episodes cured by syndromic treatment based on separate estimates for six curable STI aetiologies by gender.Results:Median overall effectiveness was 13.1% (95% CI 8.9 to 17.8%) of symptomatic curable STI episodes cured. Effectiveness increased to 25.0% (95% CI 17.3 to 33.8%), 47.6% (95% CI 44.5 to 50.8%) or 14.3% (95% CI 9.9 to 19.4%) if 100% treatment seeking, 100% correct treatment provision or 100% cure were assumed, respectively. Time-trends were difficult to assess formally but there was little evidence of decreasing STI prevalences. Including incurable but treatable herpes simplex virus (HSV)-2 ulcers in the effectiveness calculation would halve the proportion of ulcers cured or correctly treated, but this reduction could be entirely countered by including episodic antiviral treatment in the national guidelines.Conclusion:Overall effectiveness of syndromic treatment for curable STIs in rural KwaZulu-Natal remains low and there is little evidence of reduced curable STI prevalences. As syndromic treatment is likely to be a cost-saving HIV prevention intervention in South Africa, innovative strategies are urgently needed to increase rates of treatment seeking and correct treatment provision.

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Section: Resultsmentioning

confidence: 82%

Low effectiveness of syndromic treatment services for curable sexually transmitted infections in rural South Africa

White

Moodley

McGrath

et al. 2008

Sexually Transmitted Infections

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“…In response to clinical failures in patients treated with ciprofloxacin in Durban, South Africa, Moodley et al measured a 22% prevalence of quinolone resistance in 139 N. gonorrhoeae isolates by using molecular methods (32). Among men attending health clinics in Cape Town and Johannesburg, the prevalence of ciprofloxacin resistance increased from 7% and 11%, respectively, in 2004 to 27% and 32%, respectively, in 2007 (25), while a 2004-2005 study in the Pretoria region found 7% quinolone resistance (13).…”

Section: Discussionmentioning

confidence: 99%

Emergence of Quinolone Resistance and Cephalosporin MIC Creep in Neisseria gonorrhoeae Isolates from a Cohort of Young Men in Kisumu, Kenya, 2002 to 2009

Mehta

Maclean

Ndinya‐Achola

et al. 2011

Antimicrob Agents Chemother

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We evaluated antimicrobial resistance in Neisseria gonorrhoeae isolated from men enrolled in a randomized trial of male circumcision to prevent HIV. Urethral specimens from men with discharge were cultured for N. gonorrhoeae. MICs were determined by agar dilution. Clinical and Laboratory Standards Institute (CLSI) criteria defined resistance: penicillin, tetracycline, and azithromycin MICs of >2.0 g/ml; a ciprofloxacin MIC of >1.0 g/ml; and a spectinomycin MIC of >128.0 g/ml. Susceptibility to ceftriaxone and cefixime was shown by an MIC of <0.25 g/ml. Additionally, PCR amplification identified mutations in parC and gyrA genes in selected isolates. From 2002 to 2009, 168 N. gonorrhoeae isolates were obtained from 142 men. Plasmidmediated penicillin resistance was found in 65%, plasmid-mediated tetracycline resistance in 97%, and 11% were ciprofloxacin resistant (quinolone-resistant N. gonorrhoeae [QRNG]). QRNG appeared in November 2007, increasing from 9.5% in 2007 to 50% in 2009. Resistance was not detected for spectinomycin, cefixime, ceftriaxone, or azithromycin, but MICs of cefixime (P ‫؍‬ 0.018), ceftriaxone (P < 0.001), and azithromycin (P ‫؍‬ 0.097) increased over time. In a random sample of 51 men, gentamicin MICs were as follows: 4 g/ml (n ‫؍‬ 1), 8 g/ml (n ‫؍‬ 49), and 16 g/ml (n ‫؍‬ 1). QRNG increased rapidly and alternative regimens are required for N. gonorrhoeae treatment in this area. Amid emerging multidrug-resistant N. gonorrhoeae, antimicrobial resistance surveillance is essential for effective drug choice. High levels of plasmid-mediated resistance and increasing MICs for cephalosporins suggest that selective pressure from antibiotic use is a strong driver of resistance emergence.

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“…(2,9,10). However, the method has also been used, as it is here, to compare gonococcal isolates recovered from different years across whole countries (7,13,14,16,26). The method has some drawbacks for this purpose, as variant STs that differ at either porB or tbpB and then at both loci will rapidly be generated.…”

Section: Overview Of Qrng Isolates Recovered Between 1997 and 2007mentioning

confidence: 99%

Analysis of Emergence of Quinolone-Resistant Gonococci in Greece by Combined Use of Neisseria gonorrhoeae Multiantigen Sequence Typing and Multilocus Sequence Typing

et al. 2011

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Molecular Epidemiology of Recently Emergent Ciprofloxacin-Resistant Neisseria gonorrhoeae in South Africa

Abstract: : The results underscore the urgency of review of the current treatment guidelines for discharge disease in KwaZuluNatal.

Cited by 18 publications

References 12 publications

Low effectiveness of syndromic treatment services for curable sexually transmitted infections in rural South Africa

Low effectiveness of syndromic treatment services for curable sexually transmitted infections in rural South Africa

Emergence of Quinolone Resistance and Cephalosporin MIC Creep in Neisseria gonorrhoeae Isolates from a Cohort of Young Men in Kisumu, Kenya, 2002 to 2009

Analysis of Emergence of Quinolone-Resistant Gonococci in Greece by Combined Use of Neisseria gonorrhoeae Multiantigen Sequence Typing and Multilocus Sequence Typing

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