title: Increasing prevalence of penicillinase-producing Neisseria gonorrhoeae and the emergence of high-level, plasmid-mediated tetracycline resistance among gonococcal isolates in The Gambia.
abstract: One hundred and three strains of Neisseria gonorrhoeae isolated from a periurban STD clinic in The Gambia were studied for antimicrobial susceptibility, plasmid profile, and serogroup using standard procedures. Seventy-nine (77%) were penicillinase producers (PPNG) and fully resistant to penicillin (MIC > or = 8 mg/l). One isolate showed chromosomally induced resistance to penicillin (MIC 2 mg/l). None of the isolates was sensitive to tetracycline; 16 (16%) showed intermediate resistance (MICs 1-8 mg/l) and 87 (84%) showed high-level plasmid-mediated resistance (TRNG) (MICs > 10 mg/l). This is the first report of TRNG in The Gambia. Only 6 (6%) strains were fully sensitive to trimethoprim-sulphamethoxazole (MIC < 8 mg/l); 78 (76%) showed intermediate level resistance (MICs 8-16 mg/l) and 19 (18%) were fully resistant (MIC > 32 mg/l). Indications of an increase in MIC to ciprofloxacin and ceftriaxone were found in 6 (6%) and 1 (1%) strains, respectively, although all remained fully sensitive (MICs 0.004-0.03 mg/l and 0.001-0.015 mg/l). All PPNG and TRNG strains carried the 3.2 MDa and 25.2 MDa plasmids, respectively. All isolates carried the 2.6 MDa cryptic plasmid and 9 (3 PPNG and 6 non-PPNG) carried the 24.5 MDa conjugative plasmid. Forty-four (43%) strains were typed group W1, 58 (56%) W11/111 and 1 had cross-reacting antigens. Because PPNG are frequently encountered and high-level TRNG is now prevalent, the newer cephalosporins and quinolones must now be considered as first-line drugs for the treatment of gonorrhoea in The Gambia.
authors.affiliation: Medical Research Council Laboratories, Fajara, The Gambia.
authors.forename: R A
authors.initials: RA
authors.lastname: Adegbola
authors.forename: S
authors.initials: S
authors.lastname: Sabally
authors.forename: T
authors.initials: T
authors.lastname: Corrah
authors.forename: B
authors.initials: B
authors.lastname: West
authors.forename: D
authors.initials: D
authors.lastname: Mabey
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology; D004352:Drug Resistance, Microbial; D005714:Gambia / Q000453:epidemiology; D006069:Gonorrhea / Q000188:drug therapy* / Q000453:epidemiology* / Q000235:genetics; D006801:Humans; D008826:Microbial Sensitivity Tests; D009344:Neisseria gonorrhoeae / Q000187:drug effects* / Q000235:genetics*; D010403:Penicillin Resistance; D010405:Penicillinase / Q000378:metabolism; D010957:Plasmids / Q000235:genetics; D015995:Prevalence; D016036:Seroepidemiologic Studies; D013753:Tetracycline Resistance / Q000235:genetics*
chemical_list: D000900:Anti-Bacterial Agents; D010405:Penicillinase