Content area
Full Text
Background and objective
There were 82.4 million new gonorrhoea cases worldwide in 2020. Dual treatment with ceftriaxone or cefixime and azithromycin or doxycycline is currently recommended for gonorrhoea in Indonesia. However, reduced susceptibility and resistance to cephalosporins and azithromycin are increasing. We evaluated the susceptibility pattern of Neisseria gonorrhoeae to cefixime, ceftriaxone, azithromycin and doxycycline.
Methods
N. gonorrhoeae isolates were obtained from 19 male participants with clinically and laboratory-confirmed gonorrhoea. Antibiotic susceptibility testing was conducted by disc diffusion and interpreted according to Clinical and Laboratory Standards Institute and Centers for Disease Control and Prevention criteria.
Results
Reduced susceptibility or resistance was observed against doxycycline in 19 isolates (100%), cefixime in six (31.6%), ceftriaxone in three (15.8%) and azithromycin in zero (0%) isolates.
Discussion
A dual treatment regimen with ceftriaxone and azithromycin can still be recommended as first-line therapy for gonorrhoea in Indonesia. Antibiotic susceptibility surveillance of N. gonorrhoeae should be routinely conducted.
the world health organization (WHO) reported approximately 82.4 million new gonorrhoea cases in 2020, which did not change considerably from 87 million cases in 2018. Among the six WHO regions, the Western Pacific Region, including Australia, and the South East Asia Region, including Indonesia, ranked first and second in the number of new gonorrhoea cases in 2020, with 23.2 and 21.1 million cases, respectively.1 Local data from the Dermatology and Venereology Department of Dr. Soetomo General Academic Hospital in Surabaya, Indonesia, also showed that gonorrhoea represented 4.1% of new sexually transmitted infection (STI) cases from 2013 to 2015.2
The management and control of gonorrhoea has been complicated by the emergence of antimicrobial resistance (AMR) in Neisseria gonorrhoeae.*'4 In the 1930s, sulphonamides were the first effective antibiotics for gonorrhoea, but resistance developed within the decade. In the 1940s, penicillin became the drug of choice for gonorrhoea. However, chromosomal-mediated resistance rapidly developed, resulting in a more than 100-fold increment in the penicillin dose required to cure gonorrhoea. In the 1970s, the emergence of penicillinase-producing N. gonorrhoeae (PPNG) rendered penicillin ineffective. Similarly, the introduction of tetracycline, spectinomycin and fluoroquinolones to treat gonorrhoea was followed by widespread resistance, leading to their discontinuation as drugs of choice.5'6 In the 1990s, third generation cephalosporins, ceftriaxone and cefixime, were introduced for gonorrhoea. In 2010, due to the decreasing susceptibility of...