Establishment of a Gonococcal Antimicrobial Surveillance Programme, in Accordance With World Health Organization Standards, in Côte dʼIvoire, Western Africa, 2014–2017

BACKGROUNDAntimicrobial resistance (AMR) in Neisseria gonorrhoeae is compromising the treatment of gonorrhea globally. Recent AMR data are extremely limited in Africa, and mainly totally lacking in Western Africa, including Côte dʼIvoire. This study (i) established a quality-assured gonococcal antim...

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Published in:	Sexually transmitted diseases Vol. 46; no. 3; pp. 179 - 184
Main Authors:	Yéo, Alain, Kouamé-Blavo, Belinda, Kouamé, Clarisse E, Ouattara, Abdoulaye, Yao, Ahou C, Gbedé, Brigitte D, Bazan, Francis, Faye-Ketté, Hortense, Dosso, Mireille, Wi, Teodora, Unemo, Magnus
Format:	Journal Article
Language:	English
Published:	United States Copyright American Sexually Transmitted Diseases Association 01-03-2019 Lippincott Williams & Wilkins Ovid Technologies
Subjects:	Adolescent Adult Anti-Bacterial Agents - adverse effects Anti-Bacterial Agents - therapeutic use Antiinfectives and antibacterials Antimicrobial agents Antimicrobial resistance Azithromycin Azithromycin - adverse effects Azithromycin - therapeutic use Benzylpenicillin Breakpoints Cefixime Ceftriaxone Ciprofloxacin Ciprofloxacin - adverse effects Ciprofloxacin - therapeutic use Cote d'Ivoire - epidemiology Data quality Disease control Disease transmission Disks Drug resistance Drug Resistance, Multiple, Bacterial - drug effects Female Females Gentamicin Gonorrhea Gonorrhea - drug therapy Gonorrhea - epidemiology Gonorrhea - microbiology Health High resistance Humans Male Males Microbial Sensitivity Tests Middle Aged Neisseria gonorrhoeae - drug effects Neisseria gonorrhoeae - isolation & purification Prescribing Prevalence Quality assurance Sentinel Surveillance Sexual behavior Sexual orientation Sexual partners Sexually transmitted diseases Signs and symptoms Spectinomycin STD Surveillance Surveillance systems Susceptibility Tetracycline Treatment Failure World Health Organization Young Adult Cote d'Ivoire Africa
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Summary:	BACKGROUNDAntimicrobial resistance (AMR) in Neisseria gonorrhoeae is compromising the treatment of gonorrhea globally. Recent AMR data are extremely limited in Africa, and mainly totally lacking in Western Africa, including Côte dʼIvoire. This study (i) established a quality-assured gonococcal antimicrobial surveillance program, according to World Health Organization quality criteria, (ii) investigated the AMR to 8 therapeutic antimicrobials in gonococcal isolates from 2014 to 2017, and (iii) provided evidence for updating the National Sexually Transmitted Disease Syndromic Management Guidelines in Côte dʼIvoire. METHODSDuring 2014 to 2017, gonococcal isolates were obtained from sexually active symptomatic or asymptomatic males and females in 14 sites in Côte dʼIvoire. It was a special focus on symptomatic males, and their sexual partners, due to the higher culture positivity rates in symptomatic males. Patient metadata were collected, including age, gender, sexual orientation, and symptoms. Minimum inhibitory concentrations of 8 antimicrobials were determined by Etest and interpreted using European Committee on Antimicrobial Susceptibility Testing breakpoints. β-lactamase production was detected using cefinase disks. RESULTSThe level of resistance, examining 212 gonococcal isolates, was as follows84.9% to tetracycline, 68.9% to benzylpenicillin, 62.7% to ciprofloxacin, 6.1% to azithromycin, and 1.4% to gentamicin. All isolates were susceptible to ceftriaxone, cefixime and spectinomycin. CONCLUSIONSWe provide the first gonococcal AMR data, quality assured according to World Health Organization standards, from Côte dʼIvoire since more than 20 years. The high ciprofloxacin resistance, which informed a revision of the national syndromic management guideline during study, and relatively high resistance to azithromycin demand an improved gonococcal antimicrobial surveillance program and increased awareness when prescribing treatment in Côte dʼIvoire.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0148-5717 1537-4521 1537-4521
DOI:	10.1097/OLQ.0000000000000943