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Challenges in the Control of Gonorrhea in South America and the Caribbean: Monitoring the Development of Resistance to Antibiotics

Dillon, Jo-Anne R. PhD*†; Ruben, Martha MD, PhD*; Li, Hui MSc*; Borthagaray, Graciela MSc; Márquez, Carolina PhD; Fiorito, Susana MD§; Galarza, Patricia MSc§; Portilla, José Luis MSc; León, Lilia BSc; Agudelo, Clara Inés BSc**; Sanabria, Olga Marina BSc**; Maldonado, Aurora RT, BSc††; Prabhakar, Parimi MD‡‡

Sexually Transmitted Diseases: February 2006 - Volume 33 - Issue 2 - p 87-95
doi: 10.1097/01.olq.0000187231.28812.29

Objective: The objective of this study was to ascertain the antimicrobial susceptibility of Neisseria gonorrhoeae isolates from 6 South American and 13 Caribbean countries participating in the Gonococcal Antimicrobial Surveillance Program (GASP) from 1990 to 1999.

Study: A GASP network of laboratories was launched in the Americas and the Caribbean during the 1990s. Standardized methods and interpretative criteria were established for the isolation of N. gonorrhoeae, strain identification, and determination, and quality control of antimicrobial susceptibility.

Results: Two countries (Argentina and Uruguay) maintained continuous surveillance during the study period. Some countries gathered data periodically and several others were unable to initiate antimicrobial surveillance as a result of lack of resources. The percentage of penicillin-resistant N. gonorrhoeae isolated in the region over the decade varied considerably (1.0–11.9% carried chromosomal resistance and 17.9–38.8% produced β-lactamase) with an overall trend to declining numbers of penicillin-resistant isolates. For tetracycline, 7.4% to 36.3% carried chromosomal resistance, whereas 12.0% to 27.4% carried plasmid-mediated resistance. There were no reports of ciprofloxacin-resistant isolates, although N. gonorrhoeae with decreased susceptibility to ciprofloxacin and azithromycin as well as spectinomycin-resistant isolates were identified in some countries.

Surveillance of the antimicrobial susceptibility of Neisseria gonorrhoeae isolates between 1990 and 1999, by the Gonococcal Antimicrobial Surveillance Program (GASP) network (South America and the Caribbean), demonstrated high percentages of resistance to penicillin and tetracycline and lower numbers of isolates with resistance to spectinomycin or reduced susceptibility to ciprofloxacin and azithromycin.

From the *Gonococcal Antimicrobial Surveillance Program (GASP) in the Americas and the Caribbean; the † Centre for Research in Biopharmaceuticals and Biotechnology, University of Ottawa, Ottawa, Canada; ‡ Universidad de la Republica, Montevideo, Uruguay; § Instituto Nacional de Microbiología, Buenos Aires, Argentina; ∥ Instituto Nacional de Salud, Lima, Peru; ¶ Instituto Nacional de Higiene “Rafael Rangel,” Caracas, Venezuela; ** Instituto Nacional de Salud, Bogotá, Colombia; †† Instituto de Salud Publica, Santiago, Chile; and the ‡‡ Caribbean Epidemiology Centre, CAREC, Port of Spain, Trinidad and Tobago

This project was partially funded by contracts from the Pan American Health Organization and the World Health Organization to the GASP Centre–Ottawa.

Correspondence: Jo-Anne R. Dillon, PhD, College of Arts and Science, University of Saskatchewan, 9 Campus Drive, c/o Arts Room 226, Saskatoon, SK, Canada S7N 5A5. E-mail:

Received for publication March 24, 2005, and accepted July 19, 2005.

© Copyright 2006 American Sexually Transmitted Diseases Association