Gonococcal antimicrobial resistance: perspectives from the African region

Many countries in Africa have weak surveillance systems for data collection of sexually transmitted infections, and hardly any programmes for gonococcal antimicrobial susceptibility assessment. The widespread adoption of the syndromic approach to the diagnosis and management of sexually transmitted infections has also meant that the collection of a genital specimen for laboratory analysis is no longer routinely done when patients present with genital complaints, and clinical staff and laboratory technicians have lost the skill to collect genital specimens and processing them for culture and antimicrobial susceptibility testing. Following reports of gonococcal antimicrobial resistance to quinolones, WHO urged countries to monitor gonococcal antimicrobial resistance in a more systematic and regular manner. Although the response in Africa has been slow to take off, a number of studies have been conducted in a few countries and plans for implementation are in place in others. However, the number of isolates studied has been small in nearly all the countries except one, and the barriers to scaling up gonococcal antimicrobial resistance surveys seem overwhelming. In spite of the studies being few and of small sample sizes, enough information can be discerned to indicate that quinolones can no longer be a medicine of choice for the treatment of gonorrhoea in Africa and the threat of antimicrobial resistance developing in Neisseria gonorrhoeae to third-generation cephalosporins is real and imminent.