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Establishment of a Gonococcal Antimicrobial Surveillance Programme, in Accordance With World Health Organization Standards, in Côte d'Ivoire, Western Africa, 2014–2017

Yéo, Alain MD*†; Kouamé-Blavo, Belinda MD*†; Kouamé, Clarisse E. MD*; Ouattara, Abdoulaye BSc*†; Yao, Ahou C. BSc*†; Gbedé, Brigitte D. BSc*†; Bazan, Francis BSc*†; Faye-Ketté, Hortense PhD*†; Dosso, Mireille PhD*; Wi, Teodora MD; Unemo, Magnus PhD§

Sexually Transmitted Diseases: March 2019 - Volume 46 - Issue 3 - p 179–184
doi: 10.1097/OLQ.0000000000000943
Original Studies

Background Antimicrobial resistance (AMR) in Neisseria gonorrhoeae is compromising the treatment of gonorrhea globally. Recent AMR data are extremely limited in Africa, and mainly totally lacking in Western Africa, including Côte d'Ivoire. This study (i) established a quality-assured gonococcal antimicrobial surveillance program, according to World Health Organization quality criteria, (ii) investigated the AMR to 8 therapeutic antimicrobials in gonococcal isolates from 2014 to 2017, and (iii) provided evidence for updating the National Sexually Transmitted Disease Syndromic Management Guidelines in Côte d'Ivoire.

Methods During 2014 to 2017, gonococcal isolates were obtained from sexually active symptomatic or asymptomatic males and females in 14 sites in Côte d'Ivoire. It was a special focus on symptomatic males, and their sexual partners, due to the higher culture positivity rates in symptomatic males. Patient metadata were collected, including age, gender, sexual orientation, and symptoms. Minimum inhibitory concentrations of 8 antimicrobials were determined by Etest and interpreted using European Committee on Antimicrobial Susceptibility Testing breakpoints. β-lactamase production was detected using cefinase disks.

Results The level of resistance, examining 212 gonococcal isolates, was as follows: 84.9% to tetracycline, 68.9% to benzylpenicillin, 62.7% to ciprofloxacin, 6.1% to azithromycin, and 1.4% to gentamicin. All isolates were susceptible to ceftriaxone, cefixime and spectinomycin.

Conclusions We provide the first gonococcal AMR data, quality assured according to World Health Organization standards, from Côte d'Ivoire since more than 20 years. The high ciprofloxacin resistance, which informed a revision of the national syndromic management guideline during study, and relatively high resistance to azithromycin demand an improved gonococcal antimicrobial surveillance program and increased awareness when prescribing treatment in Côte d'Ivoire.

Resistance to first-line urethral/vaginal discharge treatment, ciprofloxacin, in Côte d'Ivoire was 62.7% (2014–2017). National guidelines were revised and enhanced resistance surveillance is essential in Côte d'Ivoire and, generally, in Africa.

From the *Département de Bactériologie-Virologie, Institut Pasteur de Côte d'Ivoire;

Unité des Agents du Tractus Génital, Centre National de Référence des IST, Abidjan, Côte d'Ivoire;

Department of Reproductive Health, World Health Organization, Geneva, Switzerland; and

§World Health Organization Collaborating Centre for Gonorrhoea and other STIs, Department of Laboratory Medicine, Microbiology, Örebro University, Örebro, Sweden

Acknowledgements: The authors are grateful to all the Members of the National STI Network, the National Program against STI in Côte d'Ivoire.

Sources of Funding: This work was supported by funds from the Institut Pasteur de Côte d'Ivoire, Abidjan, Côte d'Ivoire and the Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland.

Conflicts of Interest: None declared.

Correspondence: Magnus Unemo, PhD, WHO Collaborating Centre for Gonorrhoea and other STIs, Department of Laboratory Medicine, Microbiology, Örebro University Hospital, SE-701 85 Örebro, Sweden. E-mail:

Received for publication July 20, 2018, and accepted October 7, 2018.

© Copyright 2019 American Sexually Transmitted Diseases Association