1
|
Kakooza F, Kiggundu R, Mboowa G, Kateete PD, Nsangi OT, Kabahita JM, Ssentalo Bagaya B, Golparian D, Unemo M. Antimicrobial susceptibility surveillance and antimicrobial resistance in Neisseria gonorrhoeae in Africa from 2001 to 2020: A mini-review. Front Microbiol 2023; 14:1148817. [PMID: 37089569 PMCID: PMC10117771 DOI: 10.3389/fmicb.2023.1148817] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 03/15/2023] [Indexed: 04/25/2023] Open
Abstract
Antimicrobial resistance (AMR) in Neisseria gonorrhoeae (NG), compromising gonorrhea treatment, is a global public health concern. Improved, quality-assured NG AMR monitoring at the global level is essential. This mini-review examined NG AMR susceptibility surveillance and AMR data from the African continent from 2001 to 2020. Eligible peer-reviewed publications (n = 30) containing NG AMR data for antimicrobials currently recommended for gonorrhea treatment were included. Overall, very limited NG surveillance and AMR data was available. Furthermore, the NG AMR surveillance studies varied greatly regarding surveillance protocols (e.g., populations and samples tested, sample size, antimicrobials examined), methodologies (e.g., antimicrobial susceptibility testing method [agar dilution, minimum inhibitory concentration (MIC) gradient strip test, disc diffusion test] and interpretative criteria), and quality assurance (internal quality controls, external quality assessments [EQA], and verification of AMR detected). Moreover, most studies examined a suboptimal number of NG isolates, i.e., less than the WHO Global Gonococcal Antimicrobial Surveillance Program (GASP) and WHO Enhanced GASP (EGASP) recommendations of ≥100 isolates per setting and year. The notable inter-study variability and frequently small sample sizes make appropriate inter-study and inter-country comparisons of AMR data difficult. In conclusion, it is imperative to establish an enhanced, standardized and quality-assured NG AMR surveillance, ideally including patient metadata and genome sequencing as in WHO EGASP, in Africa, the region with the highest gonorrhea incidence globally. This will enable the monitoring of AMR trends, detection of emerging AMR, and timely refinements of national and international gonorrhea treatment guidelines. To achieve this aim, national and international leadership, political and financial commitments are imperative.
Collapse
Affiliation(s)
- Francis Kakooza
- Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
- Department of Immunology and Molecular Biology, Makerere University College of Health Sciences, Kampala, Uganda
| | - Reuben Kiggundu
- USAID Medicines, Technologies, and Pharmaceutical Services (MTaPS) Program, Management Sciences for Health, Kampala, Uganda
| | - Gerald Mboowa
- Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
- Department of Immunology and Molecular Biology, Makerere University College of Health Sciences, Kampala, Uganda
| | - Patrick David Kateete
- Department of Immunology and Molecular Biology, Makerere University College of Health Sciences, Kampala, Uganda
| | - Olga Tendo Nsangi
- Department of Immunology and Molecular Biology, Makerere University College of Health Sciences, Kampala, Uganda
| | - Jupiter Marina Kabahita
- Department of Immunology and Molecular Biology, Makerere University College of Health Sciences, Kampala, Uganda
| | - Bernard Ssentalo Bagaya
- Department of Immunology and Molecular Biology, Makerere University College of Health Sciences, Kampala, Uganda
| | - Daniel Golparian
- WHO Collaborating Centre for Gonorrhoea and Other STIs, Department of Laboratory Medicine, Microbiology, Örebro University, Örebro, Sweden
| | - Magnus Unemo
- WHO Collaborating Centre for Gonorrhoea and Other STIs, Department of Laboratory Medicine, Microbiology, Örebro University, Örebro, Sweden
- Institute for Global Health, University College London (UCL), London, United Kingdom
- *Correspondence: Magnus Unemo,
| |
Collapse
|
2
|
Lu Z, Tadi DA, Fu J, Azizian K, Kouhsari E. Global status of Azithromycin and Erythromycin Resistance Rates in Neisseria gonorrhoeae: A Systematic Review and Meta-analysis. THE YALE JOURNAL OF BIOLOGY AND MEDICINE 2022; 95:465-478. [PMID: 36568835 PMCID: PMC9765340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Background: The widespread development of antibiotic resistance or decreased susceptibility in Neisseria gonorrhoeae (NG) infection is a global and significant human public health issue. Objectives: Therefore, this meta-analysis aimed to estimate worldwide resistance rates of NG to the azithromycin and erythromycin according to years, regions, and antimicrobial susceptibility testing (AST). Methods: We systematically searched the published studies in PubMed, Scopus, and Embase from 1988 to 2021. All analyses were conducted using Stata software. Results: The 134 reports included in the meta-analysis were performed in 51 countries and examined 165,172 NG isolates. Most of the included studies were from Asia (50 studies) and Europe (46 studies). In the metadata, the global prevalence over the past 30 years were 6% for azithromycin and 48% for erythromycin. There was substantial change in the prevalence of macrolides NG resistance over time (P <0.01). In this metadata, among 58 countries reporting resistance data for azithromycin, 17 (29.3%) countries reported that >5% of specimens had azithromycin resistance. Conclusions: The implications of this study emphasize the rigorous or improved antimicrobial stewardship, early diagnosis, contact tracing, and enhanced intensive global surveillance system are crucial for control of further spreading of gonococcal emergence of antimicrobial resistance (AMR).
Collapse
Affiliation(s)
- Zhiwei Lu
- Graduate School, Zhejiang Chinese Medical University,
Hangzhou, Zhejiang, China,Hangzhou Heyunjia Hospital, Hangzhou, Zhejiang,
China
| | - Danyal Abbasi Tadi
- Department of Veterinary, Azad University of Shahr-e
Kord, Shahr-e Kord, Iran
| | - Jinchao Fu
- Department of General Practice, Shulan (Hangzhou)
Hospital Affiliated to Zhejiang Shuren University Shulan International Medical
College, Hangzhou, Zhejiang, China,To whom all correspondence should be addressed:
Jinchao Fu, ; Ebrahim Kouhsari,
; ORCID:
https://www.orcid.org/0000-0001-5893-6483
| | - Khalil Azizian
- Department of Microbiology, Faculty of Medicine,
Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Ebrahim Kouhsari
- Laboratory Sciences Research Center, Golestan
University of Medical Sciences, Gorgan, Iran,Department of Laboratory Sciences, Faculty of
Paramedicine, Golestan University of Medical Sciences, Gorgan, Iran,To whom all correspondence should be addressed:
Jinchao Fu, ; Ebrahim Kouhsari,
; ORCID:
https://www.orcid.org/0000-0001-5893-6483
| |
Collapse
|
3
|
Stewart J, Bukusi E, Sesay FA, Oware K, Donnell D, Soge OO, Celum C, Odoyo J, Kwena ZA, Scoville CW, Violette LR, Morrison S, Simoni J, McClelland RS, Barnabas R, Gandhi M, Baeten JM. Doxycycline post-exposure prophylaxis for prevention of sexually transmitted infections among Kenyan women using HIV pre-exposure prophylaxis: study protocol for an open-label randomized trial. Trials 2022; 23:495. [PMID: 35710444 PMCID: PMC9201793 DOI: 10.1186/s13063-022-06458-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 06/09/2022] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Women in Africa face disproportionate risk of human immunodeficiency virus (HIV) acquisition, accounting for more than half of new infections in Africa and similarly face a disproportionate burden of sexually transmitted infections (STIs). Very high STI prevalence is being observed globally, especially among people taking pre-exposure prophylaxis (PrEP) for HIV prevention. Doxycycline post-exposure prophylaxis (dPEP) has been proposed as an STI prevention strategy to reduce chlamydia, syphilis, and possibly gonorrhea, and trials are ongoing among cisgender men who have sex with men (MSM) and transgender women who are taking PrEP in high-income settings. We designed and describe here the first open-label trial to determine the effectiveness of dPEP to reduce STI incidence among cisgender women. METHODS We are conducting an open-label 1:1 randomized trial of dPEP versus standard of care (STI screening and treatment and risk-reduction counseling without dPEP) among 446 Kenyan women aged ≥ 18 and ≤ 30 years old women taking PrEP. Women are followed for 12 months, with quarterly STI testing, treatment, and adherence counseling. The primary trial outcome will be the combined incidence of Chlamydia trachomatis, Neisseria gonorrhoeae, and Treponema pallidum, compared between the randomized groups. We will also assess dPEP acceptability, tolerability, safety, impact on sexual behavior, adherence, and occurrence of antimicrobial resistance (AMR) in N. gonorrhoeae and C. trachomatis isolates. Finally, we will estimate cost per incident STI case and complications averted accounting for nonadherence and benefits relative AMR or side effects. DISCUSSION The results of this trial may have immediate implications for the global epidemic of STIs and sexual health. If effective, dPEP could put STI prevention into women's hands. While dPEP may be able to prevent STIs, it carries important risks that could counter its benefits; global debate about the balance of these potential risks and benefits requires data to inform policy and implementation and our study aims to fill this gap. TRIAL REGISTRATION ClinicalTrials.gov NCT04050540 .
Collapse
Affiliation(s)
- Jenell Stewart
- Department of Global Health, University of Washington, Box 359931, 325 Ninth Ave, WA 98104 Seattle, USA
- Department of Medicine (Infectious Diseases), University of Washington, Seattle, USA
| | - Elizabeth Bukusi
- Department of Global Health, University of Washington, Box 359931, 325 Ninth Ave, WA 98104 Seattle, USA
- Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
| | - Fredericka A. Sesay
- Department of Global Health, University of Washington, Box 359931, 325 Ninth Ave, WA 98104 Seattle, USA
- Department of Epidemiology, University of Washington, Seattle, USA
| | - Kevin Oware
- Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
| | - Deborah Donnell
- Department of Global Health, University of Washington, Box 359931, 325 Ninth Ave, WA 98104 Seattle, USA
- Department of Biostatistics, University of Washington, Seattle, USA
| | - Olusegun O. Soge
- Department of Global Health, University of Washington, Box 359931, 325 Ninth Ave, WA 98104 Seattle, USA
- Department of Medicine (Infectious Diseases), University of Washington, Seattle, USA
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, USA
| | - Connie Celum
- Department of Global Health, University of Washington, Box 359931, 325 Ninth Ave, WA 98104 Seattle, USA
- Department of Medicine (Infectious Diseases), University of Washington, Seattle, USA
- Department of Epidemiology, University of Washington, Seattle, USA
| | | | | | - Caitlin W. Scoville
- Department of Global Health, University of Washington, Box 359931, 325 Ninth Ave, WA 98104 Seattle, USA
| | - Lauren R. Violette
- Department of Medicine (Infectious Diseases), University of Washington, Seattle, USA
- Department of Epidemiology, University of Washington, Seattle, USA
| | - Susan Morrison
- Department of Global Health, University of Washington, Box 359931, 325 Ninth Ave, WA 98104 Seattle, USA
| | - Jane Simoni
- Department of Psychology, University of Washington, Seattle, USA
| | - R. Scott McClelland
- Department of Global Health, University of Washington, Box 359931, 325 Ninth Ave, WA 98104 Seattle, USA
- Department of Medicine (Infectious Diseases), University of Washington, Seattle, USA
- Department of Epidemiology, University of Washington, Seattle, USA
| | - Ruanne Barnabas
- Department of Global Health, University of Washington, Box 359931, 325 Ninth Ave, WA 98104 Seattle, USA
- Department of Medicine (Infectious Diseases), University of Washington, Seattle, USA
- Department of Epidemiology, University of Washington, Seattle, USA
| | - Monica Gandhi
- Department of Medicine, Division of HIV, Infectious Diseases, and Global Medicine, University of California San Francisco, San Francisco, USA
| | - Jared M. Baeten
- Department of Global Health, University of Washington, Box 359931, 325 Ninth Ave, WA 98104 Seattle, USA
- Department of Medicine (Infectious Diseases), University of Washington, Seattle, USA
- Department of Epidemiology, University of Washington, Seattle, USA
| |
Collapse
|
4
|
Iwuji C, Pillay D, Shamu P, Murire M, Nzenze S, Cox LA, Mullick S. OUP accepted manuscript. J Antimicrob Chemother 2022; 77:2074-2093. [PMID: 35578892 PMCID: PMC9333409 DOI: 10.1093/jac/dkac159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 04/23/2022] [Indexed: 11/12/2022] Open
Abstract
Objectives Limited antimicrobial resistance (AMR) surveillance coupled with syndromic management of sexually transmitted infections (STIs) in sub-Saharan Africa (SSA) could be contributing to an increase in AMR in the region. This systematic review aimed to synthesize data on the prevalence of AMR in common STIs in SSA and identify some research gaps that exist. Methods We searched three electronic databases for studies published between 1 January 2000 and 26 May 2020. We screened the titles and abstracts for studies that potentially contained data on AMR in SSA. Then we reviewed the full text of these studies to identify articles that reported data on the prevalence of AMR in Neisseria gonorrhoeae, Chlamydia trachomatis, Trichomonas vaginalis and Mycoplasma genitalium in SSA. We summarized the data using a narrative synthesis. Results The 40 included studies reported on AMR data from 7961 N. gonorrhoeae isolates from 15 countries in SSA and 350 M. genitalium specimens from South Africa. All four SSA regions reported very high rates of ciprofloxacin, tetracycline and penicillin resistance in N. gonorrhoeae. Resistance to cefixime or ceftriaxone was observed in all regions except West Africa. Azithromycin resistance, recommended as part of dual therapy with an extended-spectrum cephalosporin for gonorrhoea, was reported in all the regions. Both macrolide and fluoroquinolone-associated resistance were reported in M. genitalium in South Africa. Studies investigating AMR in C. trachomatis and T. vaginalis were not identified. Conclusions There is a need to strengthen AMR surveillance in SSA for prompt investigation and notification of drug resistance in STIs.
Collapse
Affiliation(s)
| | - Diantha Pillay
- Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Patience Shamu
- Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Mercy Murire
- Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Susan Nzenze
- Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Laura Ashleigh Cox
- Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Saiqa Mullick
- Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| |
Collapse
|
5
|
Aitolo GL, Adeyemi OS, Afolabi BL, Owolabi AO. Neisseria gonorrhoeae Antimicrobial Resistance: Past to Present to Future. Curr Microbiol 2021; 78:867-878. [PMID: 33528603 DOI: 10.1007/s00284-021-02353-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 01/10/2021] [Indexed: 11/27/2022]
Abstract
Neisseria gonorrhoeae (gonococcus) is a Gram-negative bacterium that causes gonorrhoea-a sexually transmitted disease. This gonococcus has progressively developed resistance to most of the available antimicrobials. Only a few countries around the world have been able to run extensive surveillance programmes on gonococcal infection and antimicrobial resistance, raising a global concern. Thus, this review focuses on the mechanisms of resistance to recommended antimicrobials in the past and present time. The approaches by the scientific community in the development of novel technologies such as whole-genome sequencing to predict antimicrobial resistance, track gonococcal transmission, as well as, introduce new therapeutics like Solithromycin, Zoliflodacin, and Gepotidacin were also discussed.
Collapse
Affiliation(s)
- Georgina L Aitolo
- Department of Microbiology, Landmark University, Omu-Aran, Kwara State, Nigeria.
| | - Oluyomi S Adeyemi
- Professor of Biochemistry Medicinal Biochemistry, Infectious Diseases, Nanomedicine & Toxicology Laboratory, Department of Biochemistry, Landmark University, Omu-Aran, Kwara State, Nigeria
| | | | | |
Collapse
|
6
|
Nacht C, Agingu W, Otieno F, Odhiambo F, Mehta SD. Antimicrobial resistance patterns in Neisseria gonorrhoeae among male clients of a sexually transmitted infections clinic in Kisumu, Kenya. Int J STD AIDS 2020; 31:46-52. [PMID: 31870236 DOI: 10.1177/0956462419881087] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Approximately 11.4 million cases of gonorrhea occur in the WHO African Region annually and global incidence has been increasing. We sought to determine the distribution and types of antimicrobial resistance in Neisseria gonorrhoeae (NG) in Kisumu, Kenya. Urethral swab specimens were obtained from men attending Universities of Nairobi, Illinois, and Manitoba sexually transmitted infection clinic with urethral discharge detected on clinical exam between 29 January and 2 July 2018. Gonorrhea was confirmed by culturing on Thayer–Martin GC Culture selective media. Disk diffusion was used to measure resistance to antimicrobials. Of the 138 males with history of urethral discharge or dysuria or urethral discharge on exam identified during the surveillance period, urethral swab samples were obtained from 60 men, and 35 (58%) were culture positive. Interpretation of the disk diffusion results showed high resistance (% of isolates) to: penicillin (97%), tetracycline (100%), ciprofloxacin (100%), and doxycycline (91%). All isolates were susceptible to ceftriaxone (100%) and azithromycin (100%). We observed high rates of resistance to several drug classes, likely driven by background selective pressure, as resistance was not observed among currently recommended Kenyan therapies for urethritis. Expanded surveillance for antimicrobial resistance in NG is warranted. Agar dilution or Etest reference testing is needed for accurate assessment of resistance.
Collapse
Affiliation(s)
- Carrie Nacht
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, IL, USA
| | | | | | | | - Supriya D Mehta
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, IL, USA
| |
Collapse
|
7
|
Attram N, Agbodzi B, Dela H, Behene E, Nyarko EO, Kyei NNA, Larbi JA, Lawson BWL, Addo KK, Newman MJ, Duplessis CA, Adams N, Unemo M, Letizia AG. Antimicrobial resistance (AMR) and molecular characterization of Neisseria gonorrhoeae in Ghana, 2012-2015. PLoS One 2019; 14:e0223598. [PMID: 31600300 PMCID: PMC6786528 DOI: 10.1371/journal.pone.0223598] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 09/24/2019] [Indexed: 12/13/2022] Open
Abstract
Neisseria gonorrhoeae antimicrobial resistance (AMR) surveillance is essential for tracking the emergence and spread of AMR strains in local, national and international populations. This is crucial for developing or refining treatment guidelines. N. gonorrhoeae multiantigen sequence typing (NG-MAST) is beneficial for describing the molecular epidemiology of gonococci at national and international levels. Elucidation of AMR determinants to β-lactam drugs, is a means of monitoring the development of resistance. In Ghana, little is known about the current gonococcal AMR prevalence and no characterization of gonococcal isolates has been previously performed. In this study, gonococcal isolates (n = 44) collected from five health facilities in Ghana from 2012 to 2015, were examined using AMR testing, NG-MAST and sequencing of penA. High rates of resistance were identified to tetracycline (100%), benzylpenicillin (90.9%), and ciprofloxacin (81.8%). One isolate had a high cefixime MIC (0.75 μg/ml). Twenty-eight NG-MAST sequence types (STs) were identified, seventeen of which were novel. The isolate with the high cefixime MIC contained a mosaic penA-34 allele and belonged to NG-MAST ST1407, an internationally spreading multidrug-resistant clone that has accounted for most cefixime resistance in many countries. In conclusion, AMR testing, NG-MAST, and sequencing of the AMR determinant penA, revealed high rates of resistance to tetracycline, benzylpenicillin, and ciprofloxacin; as well as a highly diverse population of N. gonorrhoeae in Ghana. It is imperative to continue with enhanced AMR surveillance and to understand the molecular epidemiology of gonococcal strains circulating in Ghana and other African countries.
Collapse
Affiliation(s)
- Naiki Attram
- US Naval Medical Research Unit Number Three, Ghana Laboratory, Legon, Ghana
- Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana
- * E-mail: ,
| | - Bright Agbodzi
- US Naval Medical Research Unit Number Three, Ghana Laboratory, Legon, Ghana
- Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana
| | - Helena Dela
- US Naval Medical Research Unit Number Three, Ghana Laboratory, Legon, Ghana
- Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana
| | - Eric Behene
- US Naval Medical Research Unit Number Three, Ghana Laboratory, Legon, Ghana
- Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana
| | | | | | - John A. Larbi
- Department of Theoretical and Applied Biology, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Bernard W. L. Lawson
- Department of Theoretical and Applied Biology, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Kennedy K. Addo
- Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana
| | - Mercy J. Newman
- Department of Medical Microbiology, School of Biomedical and Allied Health Science, College of Health Sciences, University of Ghana, Accra, Ghana
| | | | - Nehkonti Adams
- US Naval Medical Research Unit Number Three, Ghana Laboratory, Legon, Ghana
| | - Magnus Unemo
- WHO Collaborating Centre for Gonorrhoea and other STIs, National Reference Laboratory for STIs, Department of Laboratory Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Andrew G. Letizia
- US Naval Medical Research Unit Number Three, Ghana Laboratory, Legon, Ghana
| |
Collapse
|
8
|
Kivata MW, Mbuchi M, Eyase FL, Bulimo WD, Kyanya CK, Oundo V, Muriithi SW, Andagalu B, Mbinda WM, Soge OO, McClelland RS, Sang W, Mancuso JD. gyrA and parC mutations in fluoroquinolone-resistant Neisseria gonorrhoeae isolates from Kenya. BMC Microbiol 2019; 19:76. [PMID: 30961546 PMCID: PMC6454682 DOI: 10.1186/s12866-019-1439-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 03/20/2019] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Phenotypic fluoroquinolone resistance was first reported in Western Kenya in 2009 and later in Coastal Kenya and Nairobi. Until recently gonococcal fluoroquinolone resistance mechanisms in Kenya had not been elucidated. The aim of this paper is to analyze mutations in both gyrA and parC responsible for elevated fluoroquinolone Minimum Inhibitory Concentrations (MICs) in Neisseria gonorrhoeae (GC) isolated from heterosexual individuals from different locations in Kenya between 2013 and 2017. METHODS Antimicrobial Susceptibility Tests were done on 84 GC in an ongoing Sexually Transmitted Infections (STI) surveillance program. Of the 84 isolates, 22 resistant to two or more classes of antimicrobials were chosen for analysis. Antimicrobial susceptibility tests were done using E-test (BioMerieux) and the results were interpreted with reference to European Committee on Antimicrobial Susceptibility Testing (EUCAST) standards. The isolates were sub-cultured, and whole genomes were sequenced using Illumina platform. Reads were assembled de novo using Velvet, and mutations in the GC Quinolone Resistant Determining Regions identified using Bioedit sequence alignment editor. Single Nucleotide Polymorphism based phylogeny was inferred using RaxML. RESULTS Double GyrA amino acid substitutions; S91F and D95G/D95A were identified in 20 isolates. Of these 20 isolates, 14 had an additional E91G ParC substitution and significantly higher ciprofloxacin MICs (p = 0.0044*). On the contrary, norfloxacin MICs of isolates expressing both GyrA and ParC QRDR amino acid changes were not significantly high (p = 0.82) compared to MICs of isolates expressing GyrA substitutions alone. No single GyrA substitution was found in the analyzed isolates, and no isolate contained a ParC substitution without the simultaneous presence of double GyrA substitutions. Maximum likelihood tree clustered the 22 isolates into 6 distinct clades. CONCLUSION Simultaneous presence of amino acid substitutions in ParC and GyrA has been reported to increase gonococcal fluoroquinolone resistance from different regions in the world. Our findings indicate that GyrA S91F, D95G/D95A and ParC E91G amino acid substitutions mediate high fluoroquinolone resistance in the analyzed Kenyan GC.
Collapse
Affiliation(s)
- Mary Wandia Kivata
- Institute for Biotechnology Research, Jomo Kenyatta University of Agriculture and Technology (JKUAT), P.O Box 62,000-00200, Thika, Kenya
- Department of Biological and Physical Science, Karatina University (KarU), P.O Box 1957-10101, Karatina, Kenya
| | - Margaret Mbuchi
- US Army Medical Research Directorate-Africa, P.O Box 606, 00621, Village Market, Nairobi, Kenya
- Kenya Medical Research Institute (KEMRI), P. O. Box 54840-00200, Nairobi, Kenya
| | - Fredrick Lunyagi Eyase
- US Army Medical Research Directorate-Africa, P.O Box 606, 00621, Village Market, Nairobi, Kenya
- Institute for Biotechnology Research, Jomo Kenyatta University of Agriculture and Technology (JKUAT), P.O Box 62,000-00200, Thika, Kenya
| | - Wallace Dimbuson Bulimo
- US Army Medical Research Directorate-Africa, P.O Box 606, 00621, Village Market, Nairobi, Kenya
- Department of Biochemistry, School of Medicine, University of Nairobi, P.O. Box 30197, GPO, 00100, Nairobi, Kenya
| | - Cecilia Katunge Kyanya
- US Army Medical Research Directorate-Africa, P.O Box 606, 00621, Village Market, Nairobi, Kenya
| | - Valerie Oundo
- US Army Medical Research Directorate-Africa, P.O Box 606, 00621, Village Market, Nairobi, Kenya
| | - Simon Wachira Muriithi
- US Army Medical Research Directorate-Africa, P.O Box 606, 00621, Village Market, Nairobi, Kenya
| | - Ben Andagalu
- US Army Medical Research Directorate-Africa, P.O Box 606, 00621, Village Market, Nairobi, Kenya
| | - Wilton Mwema Mbinda
- Department of Biological and Physical Science, Karatina University (KarU), P.O Box 1957-10101, Karatina, Kenya
| | - Olusegun O. Soge
- Department of Global Health and Medicine, University of Washington, 325 9th Avenue, Box 359931, Seattle, WA 98104 USA
| | - R. Scott McClelland
- Department of Global Health and Medicine, University of Washington, 325 9th Avenue, Box 359931, Seattle, WA 98104 USA
| | - Willy Sang
- US Army Medical Research Directorate-Africa, P.O Box 606, 00621, Village Market, Nairobi, Kenya
- Kenya Medical Research Institute (KEMRI), P. O. Box 54840-00200, Nairobi, Kenya
| | - James D. Mancuso
- US Army Medical Research Directorate-Africa, P.O Box 606, 00621, Village Market, Nairobi, Kenya
| |
Collapse
|
9
|
Hardick J, Crowell TA, Lombardi K, Akintunde A, Odeyemi S, Ivo A, Eluwa G, Njab J, Baral SD, Nowak RG, Quinn TC, Barbian K, Anzick S, Adebajo S, Charurat ME, Ake J, Gaydos CA. Molecular screening for Neisseria gonorrhoeae antimicrobial resistance markers in Nigerian men who have sex with men and transgender women. Int J STD AIDS 2018; 29:1273-1281. [PMID: 29969978 DOI: 10.1177/0956462418780050] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Antimicrobial-resistant Neisseria gonorrhoeae (NG) is a global public health issue that threatens effectiveness of current treatments of NG. Increased use of nucleic acid amplification tests (NAATs) in lieu of cultures makes obtaining clinical isolates for susceptibility testing difficult and samples collected in commercial transport buffer for NAATs do not preserve viable organism, while molecular methods of assessing antibiotic susceptibility do not require viable organism. We evaluated 243 NG-positive samples in Aptima transport media including urine, oral, and rectal swabs from Nigerian men who have sex with men for markers to penicillinase-producing NG, ciprofloxacin ( GyrA and ParC mutations), and extended spectrum cephalosporins (ESCs, PenA mosaic [allele X], PonA, mtrR, PorB mutations) by real-time PCR. NG DNA was recovered in 75% (183/243) of samples. Of these, 93% (171/183) were positive for at least one resistance marker. We observed a prevalence of dual resistance markers to penicillin and ciprofloxacin at 46.2% (79/171). Six percent of samples (10/171) tested positive for the PenA mosaic (allele X) ESC marker. These data indicate that antibiotic-resistant NG is common in Nigeria. Laboratory and clinical capacity building in Nigeria should include development of methods to culture NG and determine antimicrobial susceptibility.
Collapse
Affiliation(s)
- Justin Hardick
- 1 Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Trevor A Crowell
- 2 U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA.,3 Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Kara Lombardi
- 2 U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA.,3 Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Akindiran Akintunde
- 2 U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA.,4 Henry M. Jackson Foundation for the Advancement of Military Medicine, Abuja, Nigeria
| | - Sunday Odeyemi
- 2 U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA.,4 Henry M. Jackson Foundation for the Advancement of Military Medicine, Abuja, Nigeria
| | - Andrew Ivo
- 2 U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA.,4 Henry M. Jackson Foundation for the Advancement of Military Medicine, Abuja, Nigeria
| | | | - Jean Njab
- 5 Population Council Nigeria, Abuja, Nigeria
| | - Stefan D Baral
- 6 Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Rebecca G Nowak
- 7 Institute of Human Virology, University of Maryland, Baltimore, MD, USA
| | - Thomas C Quinn
- 1 Johns Hopkins University School of Medicine, Baltimore, MD, USA.,8 Division of Intramural Research, NIAID, NIH, Bethesda, MD, USA
| | - Kent Barbian
- 9 Rocky Mountain National Laboratory (RML), Hamilton, MT, USA
| | - Sarah Anzick
- 9 Rocky Mountain National Laboratory (RML), Hamilton, MT, USA
| | | | | | - Julie Ake
- 2 U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | | |
Collapse
|
10
|
Alirol E, Wi TE, Bala M, Bazzo ML, Chen XS, Deal C, Dillon JAR, Kularatne R, Heim J, Hooft van Huijsduijnen R, Hook EW, Lahra MM, Lewis DA, Ndowa F, Shafer WM, Tayler L, Workowski K, Unemo M, Balasegaram M. Multidrug-resistant gonorrhea: A research and development roadmap to discover new medicines. PLoS Med 2017; 14:e1002366. [PMID: 28746372 PMCID: PMC5528252 DOI: 10.1371/journal.pmed.1002366] [Citation(s) in RCA: 102] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Emilie Alirol and colleagues discuss the development of new treatments for gonorrhea.
Collapse
Affiliation(s)
- Emilie Alirol
- Global Antibiotics Research and Development Partnership (GARDP), Drugs for Neglected Diseases initiative (DNDi), Geneva, Switzerland
- * E-mail:
| | - Teodora E. Wi
- World Health Organization (WHO), Geneva, Switzerland
| | - Manju Bala
- Regional STD Teaching, Training & Research Centre, VMMC and Safdarjung Hospital, New Delhi, India
| | | | - Xiang-Sheng Chen
- National Center for STD Control, Chinese Academy of Medical Sciences & Peking Union Medical College Institute of Dermatology, Nanjing, China
| | - Carolyn Deal
- STD Branch, Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases (NIAID), Rockville, Maryland, United States of America
| | | | - Ranmini Kularatne
- Centre for HIV & Sexually Transmitted Infections, National Institute for Communicable Diseases, Johannesburg, South Africa
| | - Jutta Heim
- Global Antibiotics Research and Development Partnership (GARDP), Drugs for Neglected Diseases initiative (DNDi), Geneva, Switzerland
| | - Rob Hooft van Huijsduijnen
- Global Antibiotics Research and Development Partnership (GARDP), Drugs for Neglected Diseases initiative (DNDi), Geneva, Switzerland
| | - Edward W. Hook
- University of Alabama, Birmingham, Alabama, United States of America
| | - Monica M. Lahra
- World Health Organization Collaborating Centre for Sexually Transmitted Diseases, South Eastern Area Laboratory Services, The Prince of Wales Hospital, Sydney, Australia
| | - David A. Lewis
- Western Sydney Sexual Health Centre, Parramatta, NSW, Australia, and Marie Bashir Institute for Infectious Diseases and Biosecurity & Sydney Medical School-Westmead, University of Sydney, Westmead, Australia
| | | | - William M. Shafer
- Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, Georgia, United States of America, and Laboratories of Bacterial Pathogenesis, VA Medical Center, Decatur, Georgia, United States of America
| | - Liz Tayler
- World Health Organization (WHO), Geneva, Switzerland
| | - Kimberly Workowski
- Department of Medicine, Division of Infectious Diseases, Emory University, Atlanta, Georgia, United States of America
| | - Magnus Unemo
- World Health Organization Collaborating Centre for Gonorrhoea and other STIs, Örebro University, Örebro, Sweden
| | - Manica Balasegaram
- Global Antibiotics Research and Development Partnership (GARDP), Drugs for Neglected Diseases initiative (DNDi), Geneva, Switzerland
| |
Collapse
|
11
|
Mitigating the emergence and spread of multidrug- and extensively drug-resistant gonorrhea: is there sufficient support in resource-poor settings in Africa? Sex Transm Dis 2014; 41:238-9. [PMID: 24622634 DOI: 10.1097/olq.0000000000000117] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
12
|
Francis SC, Ao TT, Vanobberghen FM, Chilongani J, Hashim R, Andreasen A, Watson-Jones D, Changalucha J, Kapiga S, Hayes RJ. Epidemiology of curable sexually transmitted infections among women at increased risk for HIV in northwestern Tanzania: inadequacy of syndromic management. PLoS One 2014; 9:e101221. [PMID: 25025338 PMCID: PMC4099080 DOI: 10.1371/journal.pone.0101221] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Accepted: 06/04/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Curable, non-viral pathogens account for a significant burden of sexually transmitted infections (STIs), and there is established evidence that STIs increase both HIV acquisition and transmission. We investigated the prevalence, trends, and factors associated with Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis and Treponema pallidum, and the performance of syndromic management, among a cohort of women working in bars, hotels, and other food and recreational facilities near large-scale mines in northwestern Tanzania. METHODS HIV-negative women aged 18-44 years (N = 966) were enrolled and followed for 12 months in a microbicides feasibility study. We collected sociodemographic and behavioural data, performed clinical examinations, and tested for STIs, at enrolment and 3-monthly. Risk factors for STIs were investigated using logistic regression models with random effects. Sensitivity, specificity and predictive values of syndromic management were calculated. RESULTS At enrolment, the prevalences of C. trachomatis, N. gonorrhoeae, T. vaginalis, and high-titre active syphilis were 111/956 (12%), 42/955 (4%), 184/945 (19%) and 46/965 (5%), respectively. There were significant decreases over time for C. trachomatis and T. vaginalis (OR trend per month: 0.94 [95% CI 0.91, 0.97]; and 0.95 [0.93, 0.98], respectively; both p<0.001). The majority of these infections were not diagnosed by the corresponding syndrome; therefore, most participants were not treated at the diagnosis visit. Syndromic management was poorly predictive of laboratory-diagnosed infections. We identified a number of risk factors for STIs, including low educational level, some sexual behaviours, and ever having been pregnant. CONCLUSIONS This analysis demonstrates that the prevalences of curable STIs are high among women who work in food and recreational facilities in northwestern Tanzania. Most of these infections are missed by syndromic management. Accurate and affordable rapid-point-of-care tests and innovative interventions are needed to reduce the burden of STIs in this population which is at increased risk for HIV.
Collapse
Affiliation(s)
- Suzanna C. Francis
- MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania
| | - Trong T. Ao
- MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania
| | - Fiona M. Vanobberghen
- MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania
| | - Joseph Chilongani
- Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania
- National Institute for Medical Research, Mwanza, Tanzania
| | - Ramadhan Hashim
- Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania
| | - Aura Andreasen
- Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Deborah Watson-Jones
- Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Saidi Kapiga
- MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania
| | - Richard J. Hayes
- MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, United Kingdom
| |
Collapse
|
13
|
Leopold SJ, van Leth F, Tarekegn H, Schultsz C. Antimicrobial drug resistance among clinically relevant bacterial isolates in sub-Saharan Africa: a systematic review. J Antimicrob Chemother 2014; 69:2337-53. [PMID: 24879668 DOI: 10.1093/jac/dku176] [Citation(s) in RCA: 118] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Little is known about the prevalence of antimicrobial resistance (AMR) amongst bacterial pathogens in sub-Saharan Africa (sSA), despite calls for continent-wide surveillance to inform empirical treatment guidelines. METHODS We searched PubMed and additional databases for susceptibility data of key pathogens for surveillance, published between 1990 and 2013. Extracted data were standardized to a prevalence of resistance in populations of isolates and reported by clinical syndrome, microorganism, relevant antimicrobial drugs and region. RESULTS We identified 2005 publications, of which 190 were analysed. Studies predominantly originated from east sSA (61%), were hospital based (60%), were from an urban setting (73%) and reported on isolates from patients with a febrile illness (42%). Quality procedures for susceptibility testing were described in <50% of studies. Median prevalence (MP) of resistance to chloramphenicol in Enterobacteriaceae, isolated from patients with a febrile illness, ranged between 31.0% and 94.2%, whilst MP of resistance to third-generation cephalosporins ranged between 0.0% and 46.5%. MP of resistance to nalidixic acid in Salmonella enterica Typhi ranged between 15.4% and 43.2%. The limited number of studies providing prevalence data on AMR in Gram-positive pathogens or in pathogens isolated from patients with a respiratory tract infection, meningitis, urinary tract infection or hospital-acquired infection suggested high prevalence of resistance to chloramphenicol, trimethoprim/sulfamethoxazole and tetracycline and low prevalence to third-generation cephalosporins and fluoroquinolones. CONCLUSIONS Our results indicate high prevalence of AMR in clinical bacterial isolates to antimicrobial drugs commonly used in sSA. Enhanced approaches for AMR surveillance are needed to support empirical therapy in sSA.
Collapse
Affiliation(s)
- Stije J Leopold
- Department of Global Health, Amsterdam Institute for Global Health and Development, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Frank van Leth
- Department of Global Health, Amsterdam Institute for Global Health and Development, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Hayalnesh Tarekegn
- Department of Global Health, Amsterdam Institute for Global Health and Development, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Constance Schultsz
- Department of Global Health, Amsterdam Institute for Global Health and Development, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands Department of Medical Microbiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
14
|
Sanders EJ, Wahome E, Okuku HS, Thiong'o AN, Smith AD, Duncan S, Mwambi J, Shafi J, McClelland RS, Graham SM. Evaluation of WHO screening algorithm for the presumptive treatment of asymptomatic rectal gonorrhoea and chlamydia infections in at-risk MSM in Kenya. Sex Transm Infect 2014; 90:94-9. [PMID: 24327758 PMCID: PMC3932748 DOI: 10.1136/sextrans-2013-051078] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2013] [Revised: 09/19/2013] [Accepted: 10/09/2013] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES The WHO recommends that men who have sex with men (MSM) reporting unprotected receptive anal intercourse (RAI) and either multiple partners or a partner with a sexually transmitted infection (STI) in the past 6 months should be presumptively treated for asymptomatic rectal Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) infections. We evaluated this recommendation in a cohort of 'high-risk' MSM in Coastal Kenya. METHODS We assessed presence of genitourinary and rectal symptoms, and determined prevalence and 3-month incidence of rectal NG and CT infections. We performed nucleic acid amplification testing of urine and rectal swab samples collected from MSM followed prospectively, and assessed predictive values of the WHO algorithm at baseline screening. RESULTS Of 244 MSM screened, 240 (98.4%) were asymptomatic, and 147 (61.3%) reported any RAI in the past 6 months. Among 85 (35.4%) asymptomatic MSM meeting criteria for the WHO presumptive treatment (PT) recommendation, we identified 20 with rectal infections (six NG, 12 CT and two NG-CT co-infections). Among 62 asymptomatic MSM who did not meet criteria, we identified seven who were infected. The sensitivity and specificity of the WHO algorithm were 74.1% (95% CI 53.7% to 88.9%) and 45.8% (95% CI 36.7% to 55.2%), respectively. The 3-month incidence of any rectal NG or CT infection in asymptomatic men reporting any RAI was 39.7 (95% CI 24.3 to 64.8) per 100 person-years. CONCLUSIONS About one-third of asymptomatic MSM were eligible to receive PT for NG and CT infections. Among MSM who would qualify for PT of rectal STIs, the number needed to treat in order to treat one infection was four. Our results support the value of the WHO screening algorithm and recommended PT strategy in this population.
Collapse
Affiliation(s)
- Eduard J Sanders
- Centre for Geographic Medicine Research – Coast, Kenya Medical Research Institute (KEMRI), Kilifi, Kenya
- Nuffield Department of Clinical Medicine, University of Oxford, Headington, UK
| | - Elizabeth Wahome
- Centre for Geographic Medicine Research – Coast, Kenya Medical Research Institute (KEMRI), Kilifi, Kenya
| | - Haile Selassie Okuku
- Centre for Geographic Medicine Research – Coast, Kenya Medical Research Institute (KEMRI), Kilifi, Kenya
| | - Alexander N Thiong'o
- Centre for Geographic Medicine Research – Coast, Kenya Medical Research Institute (KEMRI), Kilifi, Kenya
| | - Adrian D Smith
- Department of Public Health, University of Oxford, Headington, UK
| | - Sarah Duncan
- The Churchill Hospital, University Hospitals, Oxford, UK
| | - John Mwambi
- Centre for Geographic Medicine Research – Coast, Kenya Medical Research Institute (KEMRI), Kilifi, Kenya
| | - Juma Shafi
- University of Nairobi, Nairobi, Kenya
- University of Washington, Seattle, Washington, USA
| | - R Scott McClelland
- University of Nairobi, Nairobi, Kenya
- University of Washington, Seattle, Washington, USA
| | - Susan M Graham
- Centre for Geographic Medicine Research – Coast, Kenya Medical Research Institute (KEMRI), Kilifi, Kenya
- University of Nairobi, Nairobi, Kenya
- University of Washington, Seattle, Washington, USA
| |
Collapse
|
15
|
Mugo PM, Duncan S, Mwaniki SW, Thiong'o AN, Gichuru E, Okuku HS, van der Elst EM, Smith AD, Graham SM, Sanders EJ. Cross-sectional survey of treatment practices for urethritis at pharmacies, private clinics and government health facilities in coastal Kenya: many missed opportunities for HIV prevention. Sex Transm Infect 2013; 89:583-9. [PMID: 23698510 PMCID: PMC3812900 DOI: 10.1136/sextrans-2012-050979] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background While bacterial sexually transmitted infections (STIs) are important cofactors for HIV transmission, STI control has received little attention in recent years. The aim of this study was to assess STI treatment and HIV testing referral practices among health providers in Kenya. Methods In 2011 we assessed quality of case management for male urethritis at pharmacies, private clinics and government health facilities in coastal Kenya using simulated visits at pharmacies and interviews at pharmacies and health facilities. Quality was assessed using Ministry of Health guidelines. Results Twenty (77%) of 26 pharmacies, 20 (91%) of 22 private clinics and all four government facilities in the study area took part. The median (IQR) number of adult urethritis cases per week was 5 (2–10) at pharmacies, 3 (1–3) at private clinics and 5 (2–17) at government facilities. During simulated visits, 10% of pharmacies prescribed recommended antibiotics at recommended dosages and durations and, during interviews, 28% of pharmacies and 27% of health facilities prescribed recommended antibiotics at recommended dosages and durations. Most regimens were quinolone-based. HIV testing was recommended during 10% of simulated visits, 20% of pharmacy interviews and 25% of health facility interviews. Conclusions In an area of high STI burden, most men with urethritis seek care at pharmacies and private clinics. Most providers do not comply with national guidelines and very few recommend HIV testing. In order to reduce the STI burden and mitigate HIV transmission, there is an urgent need for innovative dissemination of up-to-date guidelines and inclusion of all health providers in HIV/STI programmes.
Collapse
Affiliation(s)
- Peter M Mugo
- HIV Key Populations Studies, Kenya Medical Research Institute, , Kilifi, Kenya
| | | | | | | | | | | | | | | | | | | |
Collapse
|
16
|
|