Prevalence of drug-resistant gonorrhoea increasing in South Africa


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The antibiotic ciprofloxacin should not remain the first-line treatment for gonorrhoea in Durban, South Africa, because of increasing resistance to the drug, according to a correspondence letter in this week's issue of THE LANCET.

Gonorrhoea is a sexually transmitted infection (STI) caused by the bacteria Neisseria gonorrhoeae. In untreated gonorrhoea infections, the bacteria can spread up into the reproductive tract. The most common result of untreated gonorrhoea is a serious condition called pelvic inflammatory disease (PID). In men, if left untreated, gonorrhoea can cause infertility. Prashini Moodley and Willem Sturm (University of KwaZulu Natal, Durban, South Africa) have been testing the susceptibility of N gonorrhoaea to ciprofloxacin in isolates from The Prince Cyril Zulu Centre for Communicable Diseases in Durban since 1995. Up until 2002, all isolates were susceptible to ciprofloxacin. However, reports of treatment failure appeared in November 2003 and coincided with the appearance of ciprofloxacin-resistant N gonorrhoea isolates at a prevalence of 22%. Further reports of drug resistance have continued and have been reported to the Department of Health (DoH) in South Africa. However, ciprofloxacin has remained the first-line agent in the syndromic management package for genital discharge caused by the infection.

Professor Sturm states: "We hope that this report expedites action from the DoH to do rapid nationwide surveillance to assess the extent of the problem in South Africa. In addition, an urgent review of the syndromic management guidelines, with a view to replacing ciprofloxacin as first-line treatment in Durban, KwaZulu Natal, is long overdue."

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