INCREASING RESISTANCE OF NEISSERIA-GONORRHOEAE IN WEST AND CENTRAL-AFRICA CONSEQUENCES ON THERAPY OF GONACOCCAL INFECTION

Background and Objectives: Antimicrobial resistant strains of Neisseri a gonorrhoeae have spread with remarkable rapidity in many African cou ntries, Chromosomal resistance to penicillin, tetracycline, and thiamp henicol is frequent now, and reported prevalences of penicillinase-pro ducing N. gonorrhoeae isolates vary between 15% and 80%, Plasmid-media ted tetracycline-resistant N. gonorrhoeae isolates have been observed in several African countries, Goals: To characterize gonococcal isolat es from three sites in West and. Central Africa, to determine antimicr obial susceptibility patterns, to document the spread of plasmid-media ted resistance to penicillin and tetracycline in these three sites, an d to discuss the consequences of rising antimicrobial resistance on th e management of gonococcal infection in Africa, Study Design: Over tim e, a total of 2,288 gonococcal isolates were obtained from Abidjan, Iv ory Coast (1992-1993, n = 251), from Kigali, Rwanda (1988-1993, n = 95 2), and from Kinshasa, Zaire (1988-1990, n = 1,085), The isolates were characterized by auxotyping and serotyping, Plasmid-mediated resistan ce to penicillin and to tetracycline was determined, Antimicrobial sus ceptibility testing to ceftriaxone, ciprofloxacin, penicillin, spectin omycin, tetracycline, and thiamphenicol was performed with an agar dil ution method, Results: The prevalence of penicillinase-producing N. go norrhoeae increased significantly over time from 44% to 57% in Kigali and remained stable at a high level in Abidjan (73%) and in Kinshasa ( 67%). The frequency of tetracycline-resistant N. gonorrhoeae increased significantly during the observation periods in all three sites: from 20% to 65% in Abidjan, from 0% to 64% in Kigali, and from 14% to 41% in Kinshasa. Chromosomal resistance to penicillin was common in Kigali and Kinshasa, and chromosomal resistance to tetracycline and thiamphe nicol was frequent in all three sites, All gonococcal isolates were su sceptible to ceftriaxone, ciprofloxacin, and spectinomycin. Prototroph ic and proline requiring strains were predominant, and IA-6 was the mo st common serovar in the three sites, IB-specific serovars were more c ommon among penicillinase-producing N. gonorrhoeae and IA-specific ser ovars were more frequent among tetracycline-resistant N. gonorrhoeae, but there was no evidence for a clonal spread of resistant strains. Co nclusions: This study illustrates the high frequency of resistant gono cocci in Africa and shows that tetracycline-resistant N. gonorrhoeae h ave become highly endemic in different geographic areas of the contine nt, The use of effective drugs is essential to reduce gonorrhea transm ission, Surveillance of temporal changes in antimicrobial resistance i n gonococcal strain populations should be part of sexually transmitted diseases control programs.