Prevalence and antimicrobial susceptibility patterns of Neisseria gonorrhea among the Symptomatic Patients attending Outpatient Department in Lyatonde District Hospital Southwestern Uganda


  • Nakiwala Peace Department of Medical Laboratory Sciences, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
  • Ahabwe Elliot Department of Medical Laboratory Sciences, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
  • Nseera Lawrence Department of Medical Laboratory Sciences, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
  • Twiine Felix Department of Medical Laboratory Sciences, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
  • Richard Onyuthi Apecu Department of Medical Laboratory Sciences, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda



Antibiotic susceptibility, Neisseria gonorrhea, Prevalence, Uganda


Background: Neisseria gonorrhea is one of the neglected diseases of public health importance causing symptomatic, suppurative discharge in males and being asymptomatic in females. This cross-sectional study was aimed at determining the prevalence and susceptibility pattern of Neisseria gonorrhea to the commonly used antibiotics among symptomatic patients attending outpatient department in Lyatonde district hospital.

Methods: Urethral and endocervical swabs were collected by the attending medical laboratory technologists. The presence of gonorrhea was confirmed by culture, Gram staining and biochemical tests. Antimicrobial sensitivity test was performed using the disc diffusion method and the result was interpreted using the National Committee for Clinical Laboratory Standards guidelines.  

Results: Overall prevalence of N. gonorrhea was 4.9% with high prevalence rates of 7.7% among the young age group of 15-25 years. Low level of antimicrobial susceptibility to cefuroxime (50%) followed by erythromycin and gentamycin both at 25% was observed. An alarming resistance to ceftriaxone and ciprofloxacin at 100% followed by penicillin 75% was exhibited by the colonies.

Conclusions: The high resistant rate to ceftriaxone and ciprofloxacin obviates their use as the first line of syndromic treatment of gonorrhea in Southwestern Uganda. The use of laboratory culture for diagnosis and management of N. gonorrhea, especially with cefuroxime therapy is highly recommended.


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Author Biography

Richard Onyuthi Apecu, Department of Medical Laboratory Sciences, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda



Knapp RRJ. Neisseria and Branhamella: principles and practice of infectious disease. 3rd edn. New York: Churchill Livingstone:1995.

World Health Organization (WHO): Department of Reproductive Health and Research, Neisseria gonorrhea, Geneva.Global action plan to control the spread and impact of antimicrobial resistance in. WHO; 2012: 1-36.

Unemo MGD, Nicholas R, Ohnishi M, Galley A, Sednaoui P. High level cefixime and ceftriaxone resistant N. gonorrhea in France: novel penA mosaic allel in a successful international clone causes treatment failure. Antimicrobial Agents Chemotherapy. 2012;56:1273-80.

Bignell C. UM. European Guideline on the diagnosis and treatment of gonorrhea in adults. International Journal of Sexual Transmitted Diseases AIDS. 2012;24:85-92.

Cohen MSH, Royce RA, Kazembe P, Dyer JR, Daly CC. Reduction of concentration of HIV-1 in semen after treatment of urethritis: implications for prevention of sexual transmission of HIV-1. AIDSCAP Malawi Research Group. Lancet. 1997;349:1868-73.

World Health Organization (WHO). Surveillence of antibiotic resistance in Neisseria gonorrhea in WHO Western Pacific and South Esat Asia regions. Cummunicable Disease Intell. 2010;34(1):1-7.

Tapsall JWN, Unemo M. Meeting the public health challenge of multi-drug and extensively drug resistant N. gonorrhea in France. Expert Review Anti Infec Therapy. 2009;7:821-34.

Unemo MIC. Laboratory diagnosis of sexually transmitted infections, including human immunodeficiency virus. World Health Organization (WHO), 2013.

Del Rio CSDS, Knapp JS, Rice RJ, Schalla WO. Comparison of isolates of N. gonorrhea causing meningitis and report of gonococcal meningitis in a patient with C8 deficiency. Journal Clinical Microbiology. 1989;27:1045-49.

Onda K, LoBuglio J, Bartram J. Global access to safe water: accounting for water quality and the resulting impact on MDG progress. World Health Popul. 2013;14(3):32-44.

CDC. Antibiotic Resistant Gonorrhea. Basic Information. Division of STD Prevention, National Centre for HIV/AIDS, Viral Hepatitis, STD and TB Prevention. CDC, 2016.

Newman LRJ, VanderHoon S, Wyescorlya NS, Unemo M, Low N. Global estimates of the Prevalence and Incidence of Four Curable sexual Transmitted Infections in 2012 Base on Systematic Review and Global Reports. PloS ONE. 2015;10(12):e0143304.

Uganda Population HIV/AIDs Impact Assessment (UPHIA). Uganda Population HIV/AIDs Impact Assessment. WHO Population HIV Impact Assessment, projects, 2017.

Murray PR, Brown EJ. Neisseria gonorrhea and Moraxella catarrhalis. Manual of Clinical Microbiology, 8th Edition edn. Washington D.C.: Washington American Society Microbiology; 2003.

Wayne PA. Performance standards for antimicrobial susceptibility testing. Clinical and Laboratory Standard Institute. Document M 100, 2018.

Clinical and Laboratory Standard Institute (CLSI): Performance standards for antimicrobial susceptibility testing; 2016: 90-92.

Ali S, Sewunet T, Sahlemariam Z, Kibru G: Neisseria gonorrhoeae among suspects of sexually transmitted infection in Gambella hospital, Ethiopia: risk factors and drug resistance. BMC research notes 2016;9(1):439.

Hailemariam M, Abebe T, Mihret A, Lambiyo T. Prevalence of Neisseria gonorrhea and their antimicrobial susceptibility patterns among symptomatic women attending gynecology outpatient department in Hawassa Referral Hospital, Hawassa, Ethiopia. Ethiopian j health sciences. 2013;23(1):10-8.

Bhuiyan BU, Rahman M, Miah MRA, Nahar S, Islam N, Ahmed M, Rahman KM, Albert MJ. Antimicrobial susceptibilities and plasmid contents of Neisseria gonorrhoeae isolates from commercial sex workers in Dhaka, Bangladesh: emergence of high-level resistance to ciprofloxacin. Journal of clinical microbiology. 1999;37(4):1130-6.

Florence PA, Otim F, Okongo F, Ogwang M, Greco D. The prevalence and antibiotics susceptibility pattern of Neisseria gonorrhoeae in patients attending OPD clinics at St. Mary? s Hospital Lacor Uganda. Journal of preventive medicine and hygiene. 2012:53(4).

Zachariah R, Harries A, Nkhoma W, Arendt V, Nchingula D, Chantulo A, et al. Behavioural characteristics, prevalence of Chlamydia trachomatis and antibiotic susceptibility of Neisseria gonorrhoeae in men with urethralo discharge in Thyolo, Malawi. Transactions of the Royal Society of Tropical Medicine and Hygiene. 2002;96(3):232-5.

Unemo M, Ison C. Laboratory diagnosis of sexual transmitted infections including human immunodeficiency virus. World Health Organization (WHO), 2013.

Mahafzah AM, Al-Ramahi A,M., Asa'd A,M., El-Khateeb MS. : Prevalence of sexually transmitted infections among sexually active Jordanian females. Journal Sexual Transmitted Diseases 2008, 35(6):607-10.

PhamThi L, Cecilia SL, Ingrid MHDP, Nguyen TKC. Reproductive tract infections in women seeking abortion in Vietnam. BMC Infectious Diseases. 2009;9(1):1-9.

Ndowa F, Lusti-Narasimhan M, Unemo M. The serious threat of multidrug-resistant and untreatable gonorrhoea: the pressing need for global action to control the spread of antimicrobial resistance, and mitigate the impact on sexual and reproductive health. In: BMJ Publishing Group Ltd; 2012.

Bates J, Mrphy D, Hicks V. Annual report of the Australian Gonococcal Surveillance Programme. Commun Diseases Intell. 2009;33(3):268-74.

Warner L, Newman DR, Austin HD, Kamb ML, Douglas Jr, John M, Malotte CK, et al. Condom effectiveness for reducing transmission of gonorrhea and chlamydia: the importance of assessing partner infection status. American Journal of Epidemiology. 2004;159(3):242-51.

CDC. Sexually transmitted diseases treatment guidelines. Atlanta Morbidity Mortality Weekly Report 2014;3-180.

Korenromp EL, Wi T, Resch S, Stover J, Broutet N. Costing of National STI Program implementation for the global STI control strategy for the health sector, 2016-2021. PloS one. 2017;12(1):e0170773.

Gross Kurth, Mayaud P., Mosha F. Asymptomatic gonorrhoea and chlamydial infection in rural Tanzania. British Medical Journal. 1996;312:277-80.

CDC. Antibiotic Resistant Gonorrhea. Basic information. Division of STD Prevention, Nation Centre for HIV/AIDS, Viral Hepatitis, STD and TB Prevention. CDC, 2016.

Filipiuc S, Nicolae O, Lunca C, Iancu LS. The monitoring of Neisseria gonorrhoeae infection incidence and its resistance in Suceava County. Med Nat Iasi. 2009;113(4):1238-42.

Kidd S, Workowski KA. Management of Gonorrhea in Adolescence and Adults in the United States: an official publication of infectious disease of society of America. Clinical Infectious Diseases of America: 2015;61(8):S785-801.

Vandepitte J. Bukenya J, Weiss HA, Nakubulwa S, Francis SC, Lurie MN, et al. HIV and other sexually transmitted infections of women involved in high risk sexual behavior in Kampala Uganda. Sexually Transmitted Diseases. 2011;38:316-23.






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