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High Prevalence of Ciprofloxacin-Resistant Gonorrhea Among Female Sex Workers in Kampala, Uganda (2008–2009)

Vandepitte, Judith MD, PhD*; Hughes, Peter MSc, CSi; Matovu, Godfrey DMLT*; Bukenya, Justine MD, MPH*; Grosskurth, Heiner MD, PhD*‡; Lewis, David A. FRCP(UK) PhD§¶

Sexually Transmitted Diseases: April 2014 - Volume 41 - Issue 4 - p 233–237
doi: 10.1097/OLQ.0000000000000099
Original Study

Background: Recent antimicrobial resistance data for Neisseria gonorrhoeae are lacking in Uganda, where, until 2010, ciprofloxacin was the nationally recommended first-line treatment of presumptive gonorrhea. This study assessed the antimicrobial susceptibility patterns of N. gonorrhoeae isolates cultured from female sex workers (FSWs) in Kampala.

Methods: Gonococci were isolated from endocervical specimens collected from women enrolled in a FSW cohort for 18 months (2008–2009). Minimum inhibitory concentrations for 7 antibiotics (ciprofloxacin, cefixime, ceftriaxone, azithromycin, spectinomycin, penicillin, and tetracycline) were determined for 148 isolates using Etest strips. The European Committee on Antimicrobial Susceptibility Testing version 1.3 clinical breakpoints were used to assign susceptibility categories. The 2008 World Health Organization N. gonorrhoeae panel was used for quality assurance purposes.

Results: For ciprofloxacin, 123 (83.1%) gonococcal isolates were resistant, 2 (1.4%) had intermediate susceptibility, and 23 (15.6%) were fully susceptible. All isolates were susceptible to ceftriaxone and spectinomycin, whereas 1 isolate (0.7%) was resistant to cefixime. For azithromycin, 124 isolates (83.8%) were susceptible, 20 (13.5%) had decreased susceptibility, and 4 (2.7%) were resistant. Most isolates were resistant to penicillin (101; 68.2%) and tetracycline (144; 97.3%). The minimum inhibitory concentration ranges for each antibiotic were as follows: ciprofloxacin (0.002–32 mg/L), ceftriaxone (≤0.002–0.064 mg/L), cefixime (≤0.016–0.38 mg/L), spectinomycin (2–24 mg/L), azithromycin (0.023–1 mg/L), penicillin (0.094–32 mg/L), and tetracycline (0.019–256 mg/L).

Conclusions: The high prevalence of ciprofloxacin-resistant gonorrhea observed in Kampala-based FSW emphasizes the need for sustainable gonococcal antimicrobial resistance surveillance programs in Uganda and, in general, Africa.

The antimicrobial susceptibility of Neisseria gonorrhoeae isolates, obtained from female sex workers in Uganda, was determined. Most (83.1%) were resistant to ciprofloxacin, Uganda’s first-line treatment of gonorrhea during the study.

From the *Good Health for Women Project and †Clinical Diagnostic Laboratories, MRC/UVRI Uganda Research Unit on AIDS, Entebbe, Uganda; ‡MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK; §Centre for HIV and STIs, National Institute for Communicable Diseases, Johannesburg, South Africa; and ¶Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

Acknowledgments: The authors would like to thank the Good Health for Women Project study team for their dedication to the work and all participants for their willingness to join the study.

Funding: This study was funded by the Medical Research Council UK and the European and Developing Countries Clinical Trials Partnership.

Conflict of interest statement: D. Lewis received research funds from Merck for a urinary tract infection study in 2010 and has received support to attend scientific meetings from MSD (2012/13) and Standard Diagnostics, Inc. (2013). The other authors have no potential conflicts of interest.

Ethics approval: Approval to conduct this study was obtained from the Science and Ethics Committee of the Uganda Virus Research Institute and the Ugandan National Committee for Science and Technology. Written informed consent was obtained from all enrolled women.

Author contributions: H. Grosskurth conceived and J. Vandepitte supervised the project; P. Hughes and G. Matovu conducted all required laboratory testing; J. Bukenya coordinated the specimen collection; D. Lewis provided technical expertise; and J Vandepitte and D. Lewis analyzed the data and co-wrote the manuscript. All authors had full access to the data and take responsibility for the integrity of the data and the accuracy of the presented results.

Correspondence: Judith Vandepitte, MD, PhD, MRC/UVRI Uganda Research Unit on AIDS, PO BOX 49, Entebbe Uganda. E-mail: or

Received for publication August 5, 2013, and accepted December 27, 2013.

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