title: Phenotypic and genetic characterisation of bacterial sexually transmitted infections in Bissau, Guinea-Bissau, West Africa: a prospective cohort study.
abstract: BACKGROUND
  Knowledge regarding characteristics and transmission of Neisseria gonorrhoeae, Chlamydia trachomatis and Mycoplasma genitalium and antibiotic resistance in N gonorrhoeae in Guinea-Bissau, West Africa, is entirely lacking.
  
  
  OBJECTIVE
  To characterise N gonorrhoeae, C trachomatis and M genitalium samples from Guinea-Bissau and to define bacterial populations, possible transmission chains and for N gonorrhoeae spread of antibiotic-resistant isolates.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Two sexual health and family planning clinics, Bissau, Guinea-Bissau.
  
  
  METHODS
  Positive samples from 711 women and 27 men.
  
  
  METHODS
  Positive samples for N gonorrhoeae (n=31), C trachomatis (n=60) and M genitalium (n=30) were examined. The gonococcal isolates were characterised with antibiograms, serovar determination and N gonorrhoeae multiantigen sequence typing (NG-MAST). The C trachomatis ompA gene and the M genitalium mgpB gene were sequenced, and phylogenetic analyses were performed.
  
  
  RESULTS
  For N gonorrhoeae, the levels of resistance (intermediate susceptibility) to ciprofloxacin, erythromycin, rifampicin, ampicillin, tetracycline, penicillin G and cefuroxime were 10% (0%), 6% (10%), 13% (10%), 68% (0%), 74% (0%), 68% (16%) and 0% (84%), respectively. All isolates were susceptible to cefixime, ceftriaxone, spectinomycin and azithromycin, and the minimum inhibitory concentrations of kanamycin (range: 8-32 mg/l) and gentamicin (range: 0.75-6 mg/l) were low (no resistance breakpoints exist for these antimicrobials). 19 NG-MAST sequence types (STs) (84% novel STs) were identified. Phylogenetic analysis of the C trachomatis ompA gene revealed genovar G as most prevalent (37%), followed by genovar D (19%). 23 mgpB STs were found among the M genitalium isolates, and 67% of isolates had unique STs.
  
  
  CONCLUSIONS
  The diversity among the sexually transmitted infection (STI) pathogens may be associated with suboptimal diagnostics, contact tracing, case reporting and epidemiological surveillance. In Guinea-Bissau, additional STI studies are vital to estimate the STI burden and form the basis for a national sexual health strategy for prevention, diagnosis and surveillance of STIs.
authors.affiliation: School of Health and Medical Sciences, Örebro University, Örebro, Sweden.
authors.forename: Birgitta
authors.initials: B
authors.lastname: Olsen
authors.forename: Fredrik
authors.initials: F
authors.lastname: Månsson
authors.forename: Cidia
authors.initials: C
authors.lastname: Camara
authors.forename: Mario
authors.initials: M
authors.lastname: Monteiro
authors.forename: Ansu
authors.initials: A
authors.lastname: Biai
authors.forename: Alfredo
authors.initials: A
authors.lastname: Alves
authors.forename: Sören
authors.initials: S
authors.lastname: Andersson
authors.forename: Hans
authors.initials: H
authors.lastname: Norrgren
authors.forename: Magnus
authors.initials: M
authors.lastname: Unemo