title: Etiology and antimicrobial susceptibility of pathogens responsible for urethral discharge among men in Harare, Zimbabwe.
abstract: BACKGROUND
  Periodic etiological surveillance of sexually transmitted infection (STI) syndromes is required to validate treatment algorithms used to control STIs. However, such surveys have not been performed in Zimbabwe over the past decade.
  
  
  METHODS
  A cross-sectional study design was used to determine the prevalence of the key STI etiological agents causing male urethral discharge (MUD). Urethral swab specimens were collected for molecular analysis and Neisseria gonorrhoeae isolation from consenting men 18 years and older who presented with MUD to the 12 clinics in Harare, Zimbabwe, between November 2010 and May 2011. A validated in-house multiplex polymerase chain reaction assay was used to detect the presence of N. gonorrhoeae, Chlamydia trachomatis, Trichomonas vaginalis, and Mycoplasma genitalium. Gonococci were cultured on selective media, and antimicrobial susceptibilities were determined locally for ciprofloxacin, kanamycin, ceftriaxone, and cefixime using Etest strips, and minimum inhibitory concentrations were reported using defined breakpoints.
  
  
  RESULTS
  Among 130 participants, N. gonorrhoeae was the most frequent pathogen detected (106; 82.8%), followed by C. trachomatis (15; 11.7%), M. genitalium (6; 4.7%), and T. vaginalis (2; 1.6%). Four (6.1%) of the 66 gonococci isolated were resistant to fluoroquinolones, whereas all viable isolates were susceptible to kanamycin, cefixime, and ceftriaxone.
  
  
  CONCLUSIONS
  Gonorrhea is the most important cause of MUD in men in Harare, and our study highlights the emergence of fluoroquinolone-resistant N. gonorrhoeae. Further STI surveys are required in other regions of Zimbabwe to obtain a nationally representative picture of gonococcal burden and antimicrobial resistance among MUD patients.
authors.affiliation: From the *Centre for HIV and STI, National Institute for Communicable Diseases (NHLS), Johannesburg, South Africa; †Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; ‡STI, HIV/AIDS and TB Programmes, Ministry of Health and Child Care, Harare, Zimbabwe; §Biomedical Research and Training Institute, Harare, Zimbabwe; ¶City of Harare Health Services, Rowan Martin Building, Harare, Zimbabwe; ∥Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD; **Makerere University Walter Reed Project, Kampala, Uganda; ††Western Sydney Sexual Health Centre, Parramatta, Australia; and ‡‡Centre for Infectious Diseases and Microbiology& Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Sydney, Australia.
authors.forename: Simbarashe
authors.initials: S
authors.lastname: Takuva
authors.forename: Owen
authors.initials: O
authors.lastname: Mugurungi
authors.forename: Junior
authors.initials: J
authors.lastname: Mutsvangwa
authors.forename: Anna
authors.initials: A
authors.lastname: Machiha
authors.forename: Albert C
authors.initials: AC
authors.lastname: Mupambo
authors.forename: Venessa
authors.initials: V
authors.lastname: Maseko
authors.forename: Fatim
authors.initials: F
authors.lastname: Cham
authors.forename: Stanley
authors.initials: S
authors.lastname: Mungofa
authors.forename: Peter
authors.initials: P
authors.lastname: Mason
authors.forename: David A
authors.initials: DA
authors.lastname: Lewis
mesh_terms: D000328:Adult; D000890:Anti-Infective Agents / Q000008:administration & dosage*; D002692:Chlamydia trachomatis / Q000472:pathogenicity*; D003430:Cross-Sectional Studies; D004352:Drug Resistance, Microbial; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D009174:Mycoplasma / Q000472:pathogenicity*; D009344:Neisseria gonorrhoeae / Q000472:pathogenicity*; D015995:Prevalence; D012725:Sexual Behavior; D012749:Sexually Transmitted Diseases / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control; D014246:Trichomonas vaginalis / Q000472:pathogenicity*; D014526:Urethritis / Q000453:epidemiology / Q000209:etiology / Q000382:microbiology*; D015030:Zimbabwe
chemical_list: D000890:Anti-Infective Agents