Antimicrobial susceptibilities of Neisseria gonorrhoeae in Kigali, Rwanda,and trends of resistance between 1986 and 2000

Background: Plasmid-mediated and chromosomal-mediated resistance of Neisser ia gonorrhoeae to penicillin, tetracycline, thiamphenicol, and trimethoprim -sulfamethoxazole has spread dramatically in Africa. Monitoring of antimicr obial susceptibility is a key element in the control of sexually transmitte d diseases. Goal: To document antimicrobial susceptibilities of gonococci isolated duri ng the past 15 years in Kigali, Rwanda. Study Design: Minimal inhibitory concentrations of recently collected gonoc occal isolates of eight antimicrobials were determined. The results were co mpared with data collected for isolates obtained since 1986. Results: In 1986, 35% of the gonococcal isolates were penicillinase-produci ng N gonorrhoeae. Tetracycline-resistant N gonorrhoeae appeared in 1989. Th e prevalence of penicillinase-producing N gonorrhoeae and tetracycline-resi stant N gonorrhoeae increased significantly to 70.5% and 89.2%, respectivel y. Chromosomal resistance to penicillin, tetracycline, an thiamphenicol inc reased temporarily, then decreased significantly. Chromosomal resistance to trimethoprim-sulfamethox-azole appeared in 1988 and increased to 21.6%. Al l the isolates were susceptible to ceftriaxone, ciprofloxacin, spectinomyci n, and kanamycin. Conclusions: This study illustrated the rapidly increasing frequencies of p enicillinase-producing N gonorrhoeae and tetracycline-resistant N gonorrhoe ae. Chromosomal resistance to thiamphenicol and trimethoprim-sulfamethoxazo le excludes these drugs as alternative treatment. Programs for antimicrobia l susceptibility surveillance of N gonorrhoeae should urgently be establish ed in Africa.