Ciprofloxacin resistant gonorrhoea increasing in South Africa

Keith Alcorn
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This article is more than 19 years old.

The antibiotic ciprofloxacin should not remain the first-line treatment for gonorrhoea in Durban, South Africa, because of increasing resistance to the drug, according to a letter in this week's issue of The Lancet. The South African Department of Health should also move rapdily to investigate the scale of the problem throughout South Africa, say researchers from the University of Kwazulu Natal.

A survey at Prince Cyril Zulu Centre for Communicable Diseases in Durban in January 2005 showed that 42% of men with urethritis had ciprofloxacin-resistant gonnorrhoea, compared with 23% of isolates in January 2003.

All gonorrhoea isolates had remained sensitive to ciprofloxacin until 2002.

Glossary

first-line therapy

The regimen used when starting treatment for the first time.

antibiotics

Antibiotics, also known as antibacterials, are medications that destroy or slow down the growth of bacteria. They are used to treat diseases caused by bacteria.

drug resistance

A drug-resistant HIV strain is one which is less susceptible to the effects of one or more anti-HIV drugs because of an accumulation of HIV mutations in its genotype. Resistance can be the result of a poor adherence to treatment or of transmission of an already resistant virus.

inflammation

The general term for the body’s response to injury, including injury by an infection. The acute phase (with fever, swollen glands, sore throat, headaches, etc.) is a sign that the immune system has been triggered by a signal announcing the infection. But chronic (or persisting) inflammation, even at low grade, is problematic, as it is associated in the long term to many conditions such as heart disease or cancer. The best treatment of HIV-inflammation is antiretroviral therapy.

mucosa

Moist layer of tissue lining the body’s openings, including the genital/urinary and anal tracts, the gut and the respiratory tract.

However, reports of treatment failure appeared in November 2003 and coincided with the appearance of ciprofloxacin-resistant N gonorrhoea isolates at a prevalence of 22%. Further reports of drug resistance have continued and have been reported to the Department of Health. However, ciprofloxacin has remained the first-line agent in the syndromic management package for genital discharge caused by the infection.

“Postponing effective treatment in an area with a high prevalence of HIV and N gonorrhoea has obvious implications in terms of the transmission of both organisms”, say the authors. “The initial inappropriate treatment resulted in preferential transmission of the resistant organisms. Non-responding gonococcal disease increases the duration of mucosal inflammation, which in turn increases the likelihood of HIV transmission.”

They call for urgent revision of the syndromic management guidelines for gonorrhoea in Kwazulu Natal.

References

Moodley P, Sturm AW. Ciprofloxacin-resistant gonorrhoea in South Africa. The Lancet 366: 1159, 2005.

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