Antimicrobial susceptibility patterns of gonococcal isolates in Pretoria, South Africa, over a 20-year period (1984-2004)

This paper reviews the susceptibility profiles of Neisseria gonorrhoeae over a 20-year period in the Pretoria region. Endourethral specimens were collected from adult men with symptoms of urethritis attending primary health care clinics and private medical practitioners. These swabs were plated on enriched media for isolation of N. gonorrhoeae. Antimicrobial susceptibility of the organisms was performed using the disc diffusion and agar dilution methods. Plasmid analyses were performed on beta-lactamase-producing isolates. Penicillase-producing N. gonorrhoeae strains increased from 4% to 16%, whilst chromosomally mediated penicillin-resistant strains increased dramatically from 0% to 16% from 1984 to 2004. There was an equal distribution of the 3.2 MDa African and 4.4 MDa Asian plasmids. High-level tetracycline-resistant strains (36%) were detected for the first time in 2004. Ciprofloxacin resistance emerged at 7% in the same year. Gonococcal isolates remained susceptible to cefoxitin, ceftriaxone, cefpodoxime, and spectinomycin. However, the minimum inhibitory concentration values for spectinomycin were very close to the breakpoint. We have shown a continuing increase in resistance to penicillin (plasmid and chromosomal), the emergence of high-level tetracycline resistance and an emergence of resistance to ciprofloxacin. Susceptibility testing is essential for successful therapeutic outcomes and needs to be performed in an ongoing basis

Co-infection with Neisseria gonorrhoeae, Chlamydia trachomatis and Trichomonas vaginalis in symptomatic South African men with urethritis : implications for syndromic management

BACKGROUND: This study was undertaken to determine co-infection rates of common aetiological agents of urethritis and information regarding sexual contacts of symptomatic males presenting to a family practitioner. METHODS: Endo-urethral swab specimens were collected from 253 symptomatic men and tested for N. gonorrhoeae, C. trachomatis by the BD ProbeTec ™ ET assay and for T. vaginalis by real-time PCR. Information regarding sexual behaviour was collected by the practitioner using a structured interview. RESULTS: Of the 253 patients investigated, 50 complained of urethral discharge with/without burning on micturition (BOM), the remaining 203 only complained of BOM. N. gonorrhoeae was isolated from 45%, C. trachomatis from 15% and T. vaginalis from 5.5%. N. gonorrhoeae/C. trachomatis co-infection was diagnosed in 7.5% and T. vaginalis was detected in a higher number of males presenting without visible discharge. Similar number of men reported sexual contact only with their wives compared to men having casual sexual contacts. There were fewer gonococcal infections in men reporting sexual contact with their wives alone compared to men reporting casual sexual encounters. CONCLUSIONS: Treatment guidelines for men presenting to Primary Health Care facilities and Family Practitioners need to consider the evolving antimicrobial resistance profiles and the presence of mixed infections in symptomatic patients