Gonorrhea in Indonesia: High Prevalence of Asymptomatic Urogenital Gonorrhea but No Circulating Extended Spectrum Cephalosporins-Resistant Neisseria gonorrhoeae Strains in Jakarta, Yogyakarta, and Denpasar, Indonesia.
Little is known about the epidemiology of asymptomatic urogenital gonorrhea and antimicrobial susceptibility of Neisseria gonorrhoeae (NG) strains circulating in Indonesia. We studied these issues in 3 large Indonesian cities.



In 2014, participants were recruited from sexually transmitted infection clinics and through outreach in Jakarta, Yogyakarta, and Denpasar. Neisseria gonorrhoeae detection in genital specimens was performed with NG-qPCR at the Public Health Service in Amsterdam. Antimicrobial susceptibility was investigated using the Etest.



Among 992 participants, 781 were asymptomatic and included in the risk factors analysis: 439 (56.2%) men, 258 (33.0%) women, and 84 (10.8%) transwomen. They differed significantly in age and were mostly men who have sex with men (35.2%) and female sex workers (29.3%).Overall, 175 (22.4%) asymptomatic participants had a positive NG-qPCR result. Factors positively associated with asymptomatic urogenital gonorrhea were being recruited through outreach (vs clinic-based), inconsistent condom use, and being divorced/widowed (vs single).Among 79 urogenital cultured isolates derived from 27 symptomatic and 52 asymptomatic participants, all isolates were susceptible to ceftriaxone and cefixime, and 98.7% of isolates were susceptible to azithromycin. In contrast, resistance to doxycycline (98.7%) and ciprofloxacin (97.4%) was common.



Prevalence of asymptomatic urogenital gonorrhea among Indonesian key populations is very high. Little to no resistance against extended spectrum cephalosporins and azithromycin was observed. However, almost all isolates were resistant to doxycycline and ciprofloxacin. Strengthening outreach sexually transmitted infections services, composing guidelines to screen asymptomatic individuals, and implementing periodical antimicrobial resistance surveillance are recommended.
From the *Department of Dermatology and Venereology, Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia; †Department of Dermatology, Academic Medical Center, University of Amsterdam; ‡Department of Infectious Diseases, Public Health Service (GGD) of Amsterdam; §Center for Infections and Immunology Amsterdam (CINIMA), Academic Medical Center, University of Amsterdam; and ¶Onze Lieve Vrouwe Gasthuis (OLVG) Hospital, Amsterdam, the Netherlands.
I Putu Yuda
IP
Hananta
Alje P
AP
van Dam
Sylvia Maria
SM
Bruisten
Maarten Franciscus
MF
Schim van der Loeff
Hardyanto
H
Soebono
Henry John Christiaan
HJ
de Vries
D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D058070:Asymptomatic Diseases; D024881:Drug Resistance, Bacterial; D005260:Female; D052776:Female Urogenital Diseases / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D006069:Gonorrhea / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D006801:Humans; D007214:Indonesia / Q000453:epidemiology; D008297:Male; D052801:Male Urogenital Diseases / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D009344:Neisseria gonorrhoeae / Q000187:drug effects / Q000302:isolation & purification*; D015995:Prevalence; D012307:Risk Factors; D060386:Sex Workers; D012725:Sexual Behavior; D012747:Sexual Partners; D000072339:Sexual and Gender Minorities
D000900:Anti-Bacterial Agents