title: Escalation in the relative prevalence of ciprofloxacin-resistant gonorrhoea among men with urethral discharge in two South African cities: association with HIV seropositivity.
abstract: OBJECTIVE
  The objectives of this study were to assess the prevalence of ciprofloxacin-resistant gonorrhoea in two South African cities and to investigate the association between the isolation of ciprofloxacin-resistant Neisseria gonorrhoeae and the HIV serostatus of patients.
  
  
  METHODS
  Gonococci were cultured from endourethral swabs taken from consecutive men with urethritis attending clinics in Johannesburg and Cape Town. Minimum inhibitory concentrations (MIC) for ciprofloxacin and ceftriaxone were determined with E-tests. Isolates with a ciprofloxacin MIC of 1 mg/l or greater were defined as resistant and isolates with a ceftriaxone MIC of 0.25 mg/l or less were defined as susceptible. Rapid tests were used to screen and confirm the presence of HIV antibodies. Survey data from 2004 were used as a baseline to assess trends in gonococcal resistance to ciprofloxacin.
  
  
  RESULTS
  In 2004, the prevalence of ciprofloxacin resistance was 7% in Cape Town and 11% in Johannesburg. In 2007, 37/139 (27%) Cape Town isolates and 47/149 (32%) Johannesburg isolates were resistant to ciprofloxacin; in comparison with 2004 data, this represents 2.9-fold and 1.9-fold increases, respectively. All isolates were fully susceptible to ceftriaxone. There was a significant association between HIV seropositivity and the presence of ciprofloxacin-resistant gonorrhoea among patients (p = 0.034).
  
  
  CONCLUSIONS
  Johannesburg and Cape Town have witnessed significant rises in the prevalence of ciprofloxacin-resistant gonorrhoea among men with urethritis. The resistant phenotype is linked to HIV seropositivity. There is now an urgent need to change national first-line therapy for presumptive gonococcal infections within South Africa.
authors.affiliation: STI Reference Centre, National Institute for Communicable Diseases, Private Bag X4, Sandringham 2131, South Africa. davidl@nicd.ac.za
authors.forename: D A
authors.initials: DA
authors.lastname: Lewis
authors.forename: L
authors.initials: L
authors.lastname: Scott
authors.forename: M
authors.initials: M
authors.lastname: Slabbert
authors.forename: S
authors.initials: S
authors.lastname: Mhlongo
authors.forename: A
authors.initials: A
authors.lastname: van Zijl
authors.forename: M
authors.initials: M
authors.lastname: Sello
authors.forename: N
authors.initials: N
authors.lastname: du Plessis
authors.forename: F
authors.initials: F
authors.lastname: Radebe
authors.forename: E
authors.initials: E
authors.lastname: Wasserman
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D002443:Ceftriaxone / Q000627:therapeutic use; D002939:Ciprofloxacin / Q000627:therapeutic use*; D024881:Drug Resistance, Bacterial; D006069:Gonorrhea / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology; D006679:HIV Seropositivity / Q000150:complications* / Q000453:epidemiology; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D009344:Neisseria gonorrhoeae / Q000187:drug effects / Q000302:isolation & purification; D015995:Prevalence; D013019:South Africa / Q000453:epidemiology; D014526:Urethritis / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology
chemical_list: D000900:Anti-Bacterial Agents; D000890:Anti-Infective Agents; D002939:Ciprofloxacin; D002443:Ceftriaxone