ABSTRACT:
According to World Health Organization (WHO) estimates, Gonorrhoea is one of the most common sexually transmitted infections (STIs) in developing countries. Control of gonococcal infection is becoming increasingly difficult due to emergence of resistant strains to a wide range of antibitiotics. Recent studies have revealed a high level of resistance against antibiotics such as, penicillins and quinolones in several countries, including India. There is irrational and injudicious use of antibacterial agents, especially in the developing countries like India and is expected to worsen unless urgent and appropriate steps are initiated. This study was done with an objective to find out the prevalence and antibiotic susceptibility pattern of Neisseria gonorrhoeae. This was a prospective study conducted in a tertiary care hospital in South India from June 2013 to May 2015. Samples were collected from patients attending gynecology and STD clinic. All patients in reproductive age group who attended gynecology out patient with suspected STIs were included in the study. Antimicrobial sensitivity test was performed by Kirby-Bauer disk diffusion method using CLSI guidelines. The susceptibility to the following antimicrobial agents were assessed by: Penicillin (10 IU), Tetracycline (30µg), Ciprofloxacin (5µg), Ceftriaxone (30µg), Cefixime (5µg), Cefoxitin (30µg), Cefotaxime (10µg), Nalidixic acid (30µg). The criteria used to select the antimicrobial agents tested were based on their availability. N. gonorrhoeae ATCC 49226 strain and WHO reference strains A, C, E, G, J, K-Q were used as controls. A total of 546 samples were analyzed, out of which 49 (9%) were positive for N. gonorrhoeae. Increase in N. gonorrhoeae isolates which are resistant to multiple antimicrobial agents is now a serious problem7. In the present study maximum resistance was seen with Penicillin and no resistance was seen with Ceftriaxone and Cefixime. There is a geographical difference in resistance pattern of N. gonorrhoeae, some centres have highlighted an alarming increase in the percentage of Penicillin and Quinolones over the years8,9. Other studies from Nagpur (0%), Hyderabad (41.9%) and Kolkata (52.6%) have reported a lower percentage of Penicillin, findings similar to our study were reported from another WHO SEAR country, Thailand in 2013. Emergence of N. gonorrhoeae isolates with decreased susceptibility/resistance to ceftriaxone, as a consequence of excess utilisation of oral third-generation cephalosporins for other infectious conditions, may pose a serious threat in the management of gonorrhoea in countries like India. Antimicrobial surveillance should be done periodically to monitor the current susceptibility patterns in local hospitals. In most of the hospitals, sensitivity reports are not readily available, empirical therapy is often needed to. Regional antibiotic susceptibility studies will help in choosing an appropriate antibiotic for empirical therapy and reduce the mortality and morbidity.