Phenotypic and genetic characterisation of bacterial sexually transmitted infections in Bissau, Guinea-Bissau, West Africa: a prospective cohort study

Abstract

BackgroundKnowledge regarding characteristics and transmission of Neisseria gonorrhoeae, Chlamydia trachomatis and Mycoplasma genitalium and antibiotic resistance in N gonorrhoeae in Guinea-Bissau, West Africa, is entirely lacking.ObjectivesTo characterise N gonorrhoeae, C trachomatis and M genitalium samples from Guinea-Bissau and to define bacterial populations, possible transmission chains and for N gonorrhoeae spread of antibiotic-resistant isolates.DesignProspective cohort study.SettingTwo sexual health and family planning clinics, Bissau, Guinea-Bissau.ParticipantsPositive samples from 711 women and 27 men.Material and methodsPositive samples for N gonorrhoeae (n=31), C trachomatis (n=60) and M genitalium (n=30) were examined. The gonococcal isolates were characterised with antibiograms, serovar determination and N gonorrhoeae multiantigen sequence typing (NG-MAST). The C trachomatis ompA gene and the M genitalium mgpB gene were sequenced, and phylogenetic analyses were performed.ResultsFor N gonorrhoeae, the levels of resistance (intermediate susceptibility) to ciprofloxacin, erythromycin, rifampicin, ampicillin, tetracycline, penicillin G and cefuroxime were 10% (0%), 6% (10%), 13% (10%), 68% (0%), 74% (0%), 68% (16%) and 0% (84%), respectively. All isolates were susceptible to cefixime, ceftriaxone, spectinomycin and azithromycin, and the minimum inhibitory concentrations of kanamycin (range: 8–32 mg/l) and gentamicin (range: 0.75–6 mg/l) were low (no resistance breakpoints exist for these antimicrobials). 19 NG-MAST sequence types (STs) (84% novel STs) were identified. Phylogenetic analysis of the C trachomatis ompA gene revealed genovar G as most prevalent (37%), followed by genovar D (19%). 23 mgpB STs were found among the M genitalium isolates, and 67% of isolates had unique STs.ConclusionsThe diversity among the sexually transmitted infection (STI) pathogens may be associated with suboptimal diagnostics, contact tracing, case reporting and epidemiological surveillance. In Guinea-Bissau, additional STI studies are vital to estimate the STI burden and form the basis for a national sexual health strategy for prevention, diagnosis and surveillance of STIs.

High Resistance to Azithromycin in Clinical Samples from Patients with Sexually Transmitted Diseases in Guangxi Zhuang Autonomous Region, China

“…The three top types of T . pallidum distributing in Nanning are 14d/f (46.7%), 15d/f (13.4%) and 16d/f (11.2%), which highly corroborates the strain distribution previously reported in China[ 8 , 11 ], Rare types of 9h/c (2/178) and 15i/f (1/178) expect type j were also confirmed in our study, and all of the three strains are from migrant residents, which may explain the importation of these rare genotypes and suggest a potential linked transmission network in China.…”

“…The above theory is also supported by a high prevalence rate of azithromycin resistance to syphilis reported in other studies conducted in China, e.g. 100% in Shanghai[ 8 ] and 93.8% in Nanjing[ 9 ], while Taiwan has a much low azithromycin resistance rate (1.3% from 310 samples from patients with early syphilis) since macrolides are infrequently used in that location[ 17 ].…”

“…Monitoring for azithromycin treatment failure and resistance of T . pallidum strains to macrolides has already drawn wide attention in China, for example, one hundred percent of azithromycin-resistant cases was reported in Shanghai[ 8 ] and 93.8% in Nanjing[ 9 ], China.…”

Genital Chlamydia trachomatis and Neisseria gonorrhoeae infections among women in sub-Saharan Africa: A structured review

“…We identified 29 publications that were considered duplication of STI data from a single research study; these were excluded from further analysis. 11,24–51 After eligibility assessments, 102 study results were included in this analysis, which were published in 92 articles as eight articles had data from two countries and/or study populations and one from three (Figure 1, Table 2 and S1 Table).…”

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.…”