title: High prevalence of ciprofloxacin-resistant gonorrhea among female sex workers in Kampala, Uganda (2008-2009).
abstract: BACKGROUND
  Recent antimicrobial resistance data for Neisseria gonorrhoeae are lacking in Uganda, where, until 2010, ciprofloxacin was the nationally recommended first-line treatment of presumptive gonorrhea. This study assessed the antimicrobial susceptibility patterns of N. gonorrhoeae isolates cultured from female sex workers (FSWs) in Kampala.
  
  
  METHODS
  Gonococci were isolated from endocervical specimens collected from women enrolled in a FSW cohort for 18 months (2008-2009). Minimum inhibitory concentrations for 7 antibiotics (ciprofloxacin, cefixime, ceftriaxone, azithromycin, spectinomycin, penicillin, and tetracycline) were determined for 148 isolates using Etest strips. The European Committee on Antimicrobial Susceptibility Testing version 1.3 clinical breakpoints were used to assign susceptibility categories. The 2008 World Health Organization N. gonorrhoeae panel was used for quality assurance purposes.
  
  
  RESULTS
  For ciprofloxacin, 123 (83.1%) gonococcal isolates were resistant, 2 (1.4%) had intermediate susceptibility, and 23 (15.6%) were fully susceptible. All isolates were susceptible to ceftriaxone and spectinomycin, whereas 1 isolate (0.7%) was resistant to cefixime. For azithromycin, 124 isolates (83.8%) were susceptible, 20 (13.5%) had decreased susceptibility, and 4 (2.7%) were resistant. Most isolates were resistant to penicillin (101; 68.2%) and tetracycline (144; 97.3%). The minimum inhibitory concentration ranges for each antibiotic were as follows: ciprofloxacin (0.002-32 mg/L), ceftriaxone (≤0.002-0.064 mg/L), cefixime (≤0.016-0.38 mg/L), spectinomycin (2-24 mg/L), azithromycin (0.023-1 mg/L), penicillin (0.094-32 mg/L), and tetracycline (0.019-256 mg/L).
  
  
  CONCLUSIONS
  The high prevalence of ciprofloxacin-resistant gonorrhea observed in Kampala-based FSW emphasizes the need for sustainable gonococcal antimicrobial resistance surveillance programs in Uganda and, in general, Africa.
authors.affiliation: From the *Good Health for Women Project and †Clinical Diagnostic Laboratories, MRC/UVRI Uganda Research Unit on AIDS, Entebbe, Uganda; ‡MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK; §Centre for HIV and STIs, National Institute for Communicable Diseases, Johannesburg, South Africa; and ¶Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Judith
authors.initials: J
authors.lastname: Vandepitte
authors.forename: Peter
authors.initials: P
authors.lastname: Hughes
authors.forename: Godfrey
authors.initials: G
authors.lastname: Matovu
authors.forename: Justine
authors.initials: J
authors.lastname: Bukenya
authors.forename: Heiner
authors.initials: H
authors.lastname: Grosskurth
authors.forename: David A
authors.initials: DA
authors.lastname: Lewis
mesh_terms: D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D017963:Azithromycin / Q000627:therapeutic use*; D002584:Cervix Uteri / Q000382:microbiology; D002939:Ciprofloxacin / Q000627:therapeutic use*; D024881:Drug Resistance, Bacterial / Q000187:drug effects*; D005260:Female; D005500:Follow-Up Studies; D006069:Gonorrhea / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology; D006801:Humans; D008826:Microbial Sensitivity Tests / Q000379:methods; D009344:Neisseria gonorrhoeae / Q000187:drug effects / Q000302:isolation & purification*; D015995:Prevalence; D011785:Quality Assurance, Health Care; D060386:Sex Workers; D013048:Specimen Handling; D014454:Uganda / Q000453:epidemiology; D016387:Women's Health
chemical_list: D000900:Anti-Bacterial Agents; D002939:Ciprofloxacin; D017963:Azithromycin