Prevalence of Sexually Transmitted Infections (STIs) among Adolescents Attending Genitourinary Medicine Clinic Hospital Kuala Lumpur between 2014 and 2018

Background@#Adolescents, who aged between 10 and 19 years old, comprise about 20% of the world’s population. They are vulnerable to acquisition of sexually transmitted infections (STIs). Here, we aim to determine the demography and pattern of STIs among adolescents attending Genito-Urinary Medicine (GUM) Clinic, Hospital Kuala Lumpur (HKL).@*Methods@#This is a retrospective study on all adolescents attending GUM clinic between 2014 and 2018. Data was obtained from case notes and further analysed.@*Results@#A total of 111 adolescents attended GUM clinic between 2014 and 2018. The mean age was 18 years (range 12-19). The male to female ratio was 2.26:1. All patients were Malaysian. Only 2 were foreign nationals. The majority were Malays (85.3%) followed by Indians (11%) and Chinese (3.7%). About 46.8% were still schooling, 28.8% were employed and 23.4% were unemployed. About 8.3% had a history of substance abuse. The majority (67.6%) were heterosexual, about 17.1% were homosexual and 3.6% were bisexual. Nearly 95% engaged in unprotected sex. Majority (46%) had casual sex. The most frequent presenting symptoms for male and female adolescents were discharge (43.2%) followed by swelling/growth (23.4%). About 83% had confirmed STIs. The most common STIs among the male were gonorrhoea (44.1%), genital warts (23.4%) and non-gonococcal urethritis (14.7%). The most common STIs among the female were herpes genitalis (50%), genital warts (33.3%) and syphilis (8.3%). Six patients were infected with the human immunodeficiency virus (HIV).@*Conclusion@#The most common STI among adolescents between 2014 and 2018 was gonorrhoea for male and herpes genitalis for female.

The use of NAAT- PCR to determine asymptomatic chlamydia and gonorrhoea infections in infertile patients undergoing hysterosalpingogram at the federal medical centre, Yenagoa, South-South Nigeria

Background: The roles of Chlamydia trachomatis and Neisseria gonorrhoeae in the aetiology of infertility due to tubal occlusion have been established by various studies. These organisms may lead to pelvic infection by ascending into the upper genital tract through any instrumentation like hysterosalpingography. The objectives were to determine the prevalence of asymptomatic chlamydial and gonorrhoeal infections of the genital tract among women being investigated for infertility referred for hysterosalpingography; the relationship of these infections with tubal pathologies; and if routine endo-cervical screening and prophylactic antibiotics be recommended for these patients.Methods: This was a descriptive cross-sectional study. The study population consisted of consecutive 220 infertile women that met the inclusion criteria for this study. Consent was obtained. Endo-cervical swab was taken for NAAT-PCR for Chlamydia trachomatis and Neisseria gonorrhoeae. Hysterosalpingography was carried out. Data was analyzed using SPSS (version 22).Results: Amongst the 220 women, 9 (4.1%) had asymptomatic chlamydia infection. None had gonorrhoea infection and 211 (95.9%) had none of these two organisms. Forty-eight (21.9%) of the 220 women had bilateral tubal blockage and 9 (18.8%) out of these 48 women had asymptomatic infection with Chlamydia trachomatis.Conclusions: There is a statistically significant association between tubal blockage and chlamydia infection (p = 0.00) [RR 4.31 (3.37-5.50)]. There was no evidence to recommend routine screening/antibiotics considering the low prevalence of microbes and the absence of post-HSG pelvic infection. Results from a multicenter randomized controlled trial will be more representative.

Prevalence of syphilis, gonorrhoea and chlamydia in women in Fiji, the Federated States of Micronesia, Papua New Guinea and Samoa, 1995–2017: Spectrum-STI model estimates

Objectives@#To estimate prevalence levels of and time trends for active syphilis, gonorrhoea and chlamydia in women aged 15–49 years in four countries in the Pacific (Fiji, the Federated States of Micronesia [FSM], Papua New Guinea [PNG] and Samoa) to inform surveillance and control strategies for sexually transmitted infections (STIs).@*Methods@#The Spectrum-STI model was fitted to data from prevalence surveys and screenings of adult female populations collected during 1995−2017 and adjusted for diagnostic test performance and to account for undersampled high-risk populations. For chlamydia and gonorrhoea, data were further adjusted for age and differences between urban and rural areas.@*Results@#Prevalence levels were estimated as a percentage (95% confidence interval). In 2017, active syphilis prevalence was estimated in Fiji at 3.89% (2.82 to 5.06), in FSM at 1.48% (0.93 to 2.16), in PNG at 3.91% (1.67 to 7.24) and in Samoa at 0.16% (0.07 to 0.37). For gonorrhoea, the prevalence in Fiji was 1.63% (0.50 to 3.87); in FSM it was 1.59% (0.49 to 3.58); in PNG it was 11.0% (7.25 to 16.1); and in Samoa it was 1.61% (1.17 to 2.19). The prevalence of chlamydia in Fiji was 24.1% (16.5 to 32.7); in FSM it was 23.9% (18.5 to 30.6); in PNG it was 14.8% (7.39 to 24.7); and in Samoa it was 30.6% (26.8 to 35.0). For each specific disease within each country, the 95% confidence intervals overlapped for 2000 and 2017, although in PNG the 2017 estimates for all three STIs were below the 2000 estimates. These patterns were robust in the sen sitivity analyses.@*Discussion@#This study demonstrated a persistently high prevalence of three major bacterial STIs across four countries in WHO’s Western Pacific Region during nearly two decades. Further strengthening of strategies to control and prevent STIs is warranted.

Comparing age and sex trends of chlamydia, gonorrhoea, hepatitis and syphilis infections in Samoa in 2012 and 2017

Abstract@#In Samoa, the seroprevalence rates of sexually transmitted infections other than HIV have been endemically high over the past decade, despite years of prevention programming. Odds ratio and χ2 tests were conducted to compare the rates of positivity of chlamydia, gonorrhoea, hepatitis B and C, and syphilis across age groups from 2012 and 2017 surveillance data in Samoa. Young people aged 15–19 years were significantly more likely to have a chlamydia infection compared to all other age groups in both 2012 and 2017. Hepatitis B infections were more common in males and those aged 30 and above in both 2012 and 2017. Hepatitis C had no significant differences in age, but it was more common in males in 2012 and more common in females in 2017. Older age groups (aged 45 and above) were more likely to have a positive syphilis test in both 2014 and 2017 when compared to those aged 15–24 years. The results of this analysis confirm previously observed trends in Samoa for younger age groups’ prevalence of chlamydia and gonorrhoea, and for older age groups’ prevalence of hepatitis B and C. But the analysis also unexpectedly found that older age groups (aged 45 and above) are more likely to test positive for syphilis (for years 2014 and 2017). Further studies are needed to assess behavioural risk factors associated with older populations in order to explain the increase in risk and to design interventions suited to this demographic.

Alarming resistance of Neisseria gonorrhoeae in a tertiary care hospital of North India

Background: This study attempted to elucidate the spectrum of sexually transmitted infections in a tertiary care centre in North India and to assess the antimicrobial resistance in Neisseria gonorrhoeae. Materials and Methods: Antimicrobial resistance pattern of N. gonorrhoeae was determined by the standard techniques. Genotypic detection of gyrA, parC and blaTEM genes was also carried out. The results of gyrA gene by polymerase chain reaction were confirmed by DNA sequencing. Results: N. gonorrhoea was identified in 10 (4.98%) patients, and antimicrobial sensitivity was performed in seven patients. All the seven patients tested were quinolone-resistant N. gonorrhoeae (QRNG), 5/7 were penicillinase-producing N. gonorrhoeae, 1/7 was chromosomally mediated penicillin-resistant N. gonorrhoeae and 3/7 were tetracycline-resistant N. gonorrhoeae. Minimal inhibitory concentration (MIC) by E-test was performed in five strains, and we observed that MIC90 for ciprofloxacin was ?4 ?g/ml, for penicillin was ?6 ?g/ml and for tetracycline was 12 ?g/ml, which clearly brackets them as resistant isolates. The presence of TEM gene was confirmed genotypically in six out of seven cases. In all seven cases, gyrA and parC were observed, thus confirming their QRNG status. Conclusion: Alarming increase in the resistance to commonly used antimicrobials for gonorrhoea in our study, especially of fluoroquinolones, is a clarion call for the urgent need for prudence in prescribing them. Observing the rampant resistance exhibited by N. gonorrhoeae, it is clear that the day is not far when it will acquire a superbug status and become intractable to treatment by the available antibiotics.

World health organization global health sector strategy on sexually transmitted infections: an evidence-to-action summary for Colombia / Estrategia global de la Organización Mundial de la Salud contra infecciones de transmisión sexual: de la evidencia a la acción. Resumen para Colombia

ABSTRACT Curable and incurable sexually transmitted infections (STI) are acquired by hundreds of millions of people worldwide each year. Undiagnosed and untreated STIs cause a range of negative health outcomes including adverse birth outcomes, infertility and other long term sequelae such as cervical cancer. In 2016, the World Health Organization (WHO) launched the Global STI Strategy (20162021). The WHO Global STI Strategy's public health approach focuses on three causative organisms of STIs that need immediate action and for which cost-effective interventions exist: (a) Neisseria gonorrhoeae as a cause of infertility, a risk factor for coinfection with other STIs and because of increasing bacterial resistance to antibiotic treatment, (b) Treponema pallidum given the contribution of syphilis to adverse birth outcomes including stillbirth and neonatal death and (c) Human papillomavirus due to its link to cervical cancer. The range of actions recommended for countries includes: (a) strengthening surveillance, with program monitoring and progress evaluation, (b) STI prevention, (c) early diagnosis of STIs, (d) patient and partner management, and (e) approaches to reach the most vulnerable populations. This summary describes the WHO Global STI Strategy alongside findings from a STI surveillance workshop held in Colombia in May of 2017. Observations related to the Global STI Strategy and findings from the STI estimation workshop are described here for stakeholders in Colombia to consider as they identify opportunities to improve STI services and surveillance.

RESUMEN En el mundo, cientos de millones de personas adquieren anualmente infecciones de transmisión sexual (ITS), algunas de ellas curables y otras incurables. Las ITS que no se diagnostican y no se tratan producen una serie de desenlaces negativos para la salud, entre los cuales se cuentan malos resultados perinatales, infertilidad y otras secuelas crónicas, además del cáncer de cuello uterino. En 2016, la Organización Mundial de la Salud (OMS) lanzó la Estrategia Mundial contras las ITS (2016-2021). El enfoque de salud pública contemplado en la Estrategia Global de la OMS se centra en tres microorganismos causantes de las ITS que requieren acciones inmediatas y para los cuales existen intervenciones costo-efectivas: (a) Neisseria gonorrhoea como causa de infertilidad y factor de riesgo para coinfección con otras ITS, y por su mayor resistencia al tratamiento con antibióticos; (b) Treponema pallidum por la contribución de la sífilis a resultados adversos al nacimiento, entre ellos muerte fetal y muerte neonatal; y (c) virus del papiloma humano debido a su relación con el cáncer de cuello uterino. Entre las acciones recomendadas para los países están las siguientes: (a) fortalecer la vigilancia, el monitoreo y la evaluación de los programas y los avances logrados; (b) prevención de las ITS; (c) diagnóstico temprano de las ITS; (d) manejo del paciente y la pareja; (e) mecanismos para llegar a las poblaciones más vulnerables. Esta síntesis de la política resume la Estrategia Mundial de la OMS contra las ITS, además de los hallazgos de un taller de vigilancia llevado a cabo en Colombia en mayo de 2017. Aquí se describen las observaciones relacionadas con la Estrategia, y los hallazgos del taller a fin de que los distintos grupos de interés en Colombia, los tomen en consideración a la hora de identificar las oportunidades de mejorar los servicios y la vigilancia en lo que atañe a las ITS.

An analysis of underlying factors for seasonal variation in gonorrhoea in India: A 6-year statistical assessment.

Purpose: A statistical assessment of a disease is often necessary before resources can be allocated to any control programme. No literature on seasonal trends of gonorrhoea is available from India. Objectives: The objectives were (1) to determine, if any, seasonal trends were present in India (2) to describe factors contributing to seasonality of gonorrhoea (3) to formulate approaches for gonorrhoea control at the national level. Materials and Methods: Seasonal indices for gonorrhoea were calculated quarterly in terms of a seasonal index between 2005 and 2010. Ratio-to-moving average method was used to determine the seasonal variation. The original data values in the time-series were expressed as percentages of moving averages. Results were also analyzed by second statistical method i.e. seasonal subseries plot. Results: The seasonally adjusted average for culture-positive gonorrhoea cases was highest in the second quarter (128.61%) followed by third quarter (108.48%) while a trough was observed in the first (96.05%) and last quarter (64.85%). The second quarter peak was representative of summer vacations in schools and colleges. Moreover, April is the harvesting month followed by celebrations and social gatherings. Both these factors are associated with increased sexual activity and partner change. A trough in first and last quarter was indicative of festival season and winter leading to less patients reporting to the hospital. Conclusion: The findings highlight the immediate need to strengthen sexual health education among young people in schools and colleges and education on risk-reduction practices especially at crucial points in the calendar year for effective gonorrhoea control.

Nucleic acid amplification tests (NAATs) for gonorrhoea diagnosis in women: Experience of a tertiary care hospital in north India.

Background & objectives: Gonorrhoea is among the most frequent of the estimated bacterial sexually transmitted infections (STIs) and has significant health implications in women. The use of nucleic acid amplification tests (NAATs) has been shown to provide enhanced diagnosis of gonorrhoea in female patients. However, it is recommended that an on-going assessment of the test assays should be performed to check for any probable sequence variation occurring in the targeted region. In this study, an in-house PCR targeting opa-gene of Neisseria gonorrhoeae was used in conjunction with 16S ribosomal PCR to determine the presence of gonorrhoea in female patients attending the tertiary care hospitals. Methods: Endocervical samples collected from 250 female patients with complaints of vaginal or cervical discharge or pain in lower abdomen were tested using opa and 16S ribosomal assay. The samples were also processed by conventional methods. Results: Of the 250 female patients included in the study, only one was positive by conventional methods (microscopy and culture) whereas 17 patients were found to be positive based on PCR results. Interpretation & conclusions: The clinical sensitivity of conventional methods for the detection of N. gonorrhoeae in female patients was low. The gonococcal detection rates increased when molecular method was used giving 16 additional positives. Studies should be done to find out other gene targets that may be used in the screening assays to detect the presence of gonorrhoea.

The Management of Patients Presenting with Genital Discharge

The approach to the management of genital discharge in men and women differ due to the varying presentations and aetiologies for each. In women, non-sexually transmitted causes are typically, physiological, bacterial vaginosis and candidiasis. In men, chlamydia and gonorrhoea are the most frequent causes of urethritis. A thorough history and examination should be conducted as they provide a guide to diagnosis and treatment. Investigations are particularly important in women to confirm or exclude sexually transmitted infections which are often asymptomatic. Where a sexually transmitted infection is suspected, patients should be counselled regarding abstaining until treatment completion, notification and treatment of sex partners to reduce onward transmission and re-infection, and safe sex practices.

Uretritis gonocócica / Gonococal urethritis

La uretritis gonocócica es uno de los síndromes más comunes relacionados con la transmisión sexual. Hay diversos factores que influyen en que no se conozca su cifra real de ocurrencia; en primer lugar, el estigma social que representan estas infecciones, y en segundo, la automedicación, por lo que la cifra de casos puede ser más del doble de lo reportado en las estadísticas oficiales. Las mucosas de los órganos genitales constituyen la principal vía de entrada de la Neisseria gonorrhoeae . Este es un microorganismo que no sobrevive por mucho tiempo fuera de su hospedero, el ser humano, y sólo se transmite de persona a persona por contacto directo y por colonizar a las células del epitelio columnar de la uretra y del cérvix, así como la mucosa de garganta y recto. La manifestación más común de gonorrea es la uretritis, pero en mujeres es frecuente un curso subclínico o la cervicitis. En ellas, la gonorrea puede llevar al desarrollo de enfermedad pélvica inflamatoria, mientras que en los hombres puede producir estenosis uretral, epididimitis y prostatitis aguda o crónica. También los recién nacidos, hijos de mujeres con gonorrea, pueden desarrollar una infección conjuntival. El tratamiento actualmente recomendado incluye fluoroquinolonas, cefalosporinas de tercera generación, espectinomicina y azitromicina; sin embargo, el fenómeno de resistencia antimicrobiana contra varios de estos agentes ha sido identificado en diversos países. El patrón de resistencia antimicrobiana es mayor en países en que no existe una regulación adecuada para el uso de antimicrobianos.

Gonococcal urethritis is one of the most common syndromes related to sexual transmission. There are many factors that influence that its actual occurrence be unknown, like the social stigma that represent this infection and the self-medication; so the number of cases of gonococcal urethritis can be more than twice that are reported to the official statistics. The mucous membranes of the genital organs constitute the main route of entry of Neisseria gonorrhoeae . This is a microorganism that cannot survive for long time outside the host, is only transmitted from person to person by direct contact and colonize the columnar epithelium cells of the urethra and cervix, as well as the mucous membrane of the throat and rectum. The most common manifestation of gonorrhea is urethritis, but in women the course is often subclinical or manifested by cervicitis. In women gonorrhea can lead to pelvic inflammatory disease, while in men it can produce urethral stenosis, epididymitis and acute or chronic prostatitis. The newborn children of women with gonorrhea may develop a conjunctival infection. Treatment currently recommended includes fluoroquinolones, cephalosporins of third generation, spectinomycin, and azithromycin. However, antimicrobial resistance against several of these agents has been identified in various countries. The rate of antimicrobial resistance is greater in countries where there is no regulation for the use of antimicrobials.

Systemic lupus Erythematosus and Neisseria gonorrhoea a case of the arthritis-dermatitis syndrome

Systemic lupus erythematosus (SLE) is a systemic disease characterized by arthritis among other protean manifestations. Occasionally lupus flares occur and is associated with increasing joint pains. In this state, complement is activated and leads to precipitation of immune complexes. Neisserial infections are cleared by complement and so in the presence of deficient complement, these infections will flourish. Disseminated gonococcal infection (DGI) occurs infrequently. A case of Neisseria gonorrhoea presenting as the arthritis-dermatitis syndrome which mimicked a lupus flare is presented and the appropriate literature reviewed.

Monitoring Antimicrobial Susceptibility of Neisseria gonorrhoeae Isolated from Bangladesh during 1997-2006: Emergence and Pattern of Drug-resistant Isolates.

Gonorrhoea is one of the most common sexually transmitted infections (STIs) in developing countries, and the emergence of resistance to antimicrobial agents in Neisseria gonorrhoeae is a major obstacle in the control of gonorrhoea. Periodical monitoring of antimicrobial susceptibility of N. gonorrhoeae is essential for the early detection of emergence of drug resistance. In total, 1,767 gonococcal strains isolated from males and females (general population and those with high-risk behaviour) from different parts of Bangladesh were studied during 1997-2006. Minimum inhibitory concentrations of penicillin, tetracycline, ciprofloxacin, ceftriaxone, spectinomycin, and azithromycin for the isolates were determined by the agar dilution method. Isolates resistant to three or more antimicrobial agents are considered multidrug-resistant. The prevalence of plasmid-mediated penicillinase-producing N. gonorrhoeae (PPNG) and plasmid-mediated tetracycline-resistant N. gonorrhoeae (TRNG) was determined. Nine percent of the isolates were resistant to ciprofloxacin in 1997 compared to 87% in 2006. Multidrug-resistant N. gonorrhoeae have emerged in 1997, and 44% of the strains (n=66) isolated during 2006 were multidrug-resistant. Forty-two percent of the isolates in 2006 were both PPNG- and TRNG-positive compared to none in 1997. The rapidly-changing pattern of gonococcal antimicrobial susceptibility warrants the need for an antimicrobial susceptibilitymonitoring programme, and periodical analysis and dissemination of susceptibility data are essential to guide clinicians and for successful STI/HIV intervention programmes.

Defaulter rate of follow-up of patients with gonorrhoea at the Genitourinary Medicine Clinic

Backround Gonorrhoea is the third most common sexually transmitted infection (STI) in the Genitourinary Medicine Clinic. Despite high cure rates achieved with the use of intramuscular ceftriaxone, all patients with gonorrhoea are followed up with one test of cure (gonococcal culture) after treatment. This is essential to ensure success of cure hence preventing complications, to screen for and treat concomitant STIs, and to reduce the possibility of re-infection through repeated patient education. A defaulter is defined as a patient who fails to attend follow-up and undergo test of cure within a period of 2 weeks after completion of treatment. Previous studies showed high defaulter rates of 41.1% and 43.8% in 1996 and 1997 respectively. This study aims to determine the defaulter rate of follow-up of patients with gonorrhoea, and to formulate remedial measures to reduce defaulter rate and thereby improve the management of gonorrhoea specifically and all sexually transmitted infections in general. Materials and Methods An audit of defaulter rate of patients diagnosed as gonorrhoea was performed from January 1998 to December 2005 in the Genitourinary Medicine Clinic, Department of Dermatology, Kuala Lumpur Hospital. All patients who failed to attend follow-up visit within 2 weeks after treatment were recorded as defaulters. An analysis was performed on all defaulters from January to December 2005. Results Defaulter rates for patients with gonorrhoea were generally high throughout the years studied, ranging from 35.0% to 48.2%, the highest being in year 2001. Despite continuous and relentless efforts in patient education and counseling, there has been no decreasing trend. In the year 2005, all defaulters were males. Majority (72.1%) of the defaulters were young adults aged between 21 and 40 years. 67.4% of the defaulters were Malay, followed by Indian 14.0%, Chinese 7.0% and other ethnic groups 11.6%. Among the defaulters, 30.2% had repeated gonococcal infection and 38.5% had concomitant STIs. Conclusions More effort is necessary in educating patients to attend follow-up visit after treatment of gonorrhoea. Emphasis has to be made on the importance of confirming cure and thereby preventing complications and transmission to sexual partners. Counseling should also be given to all patients regarding practice of safe sex to prevent gonococcal re-infection and other STIs.

Antibiotic Resistance Pattern of Neisseria gonorrhoeae in Hospital Kuala Lumpur, Malaysia (2001-2005)

Background Gonorrhoea is the third most common sexually transmitted infection (after syphilis and non-gonococcal urethritis) seen in patients attending the Genitourinary Medicine (GUM) Clinic in Hospital Kuala Lumpur (HKL). Its association with poor reproductive health outcomes and the increasing prevalence of antimicrobial resistance has made it a major public health concern. Objective To determine the antibiotic resistance pattern of Neisseria Gonorrhoeae in patients attending the GUM Clinic in HKL and its comparison with other countries. Method A retrospective study of all patients with gonorrhoea (new and recurrent) between 2001-2005. Antimicrobial susceptibility testing by standard disc diffusion method was performed to detect sensitivity to penicillin, tetracycline, kanamycin, ciprofloxacin, spectinomycin, ceftriaxone and cefuroxime. Results A total of 416 positive culture isolates of N.gonorrhoeae from 2001-2005 were reviewed. Highest level of resistance was detected to tetracycline (86.8% of 296 isolates). Resistance to penicillin was noted in 64.4% of all isolates. Penicillinase Producing N.gonorrhoeae (PPNG) accounted for 62% of cases. Both penicillin and tetracycline showed an increasing resistance trend from 2001-2005. The third commonest antibiotic resistance was to kanamycin (38.3%), followed by ciprofloxacin (10.4%). The resistance to spectinomycin was 1.7%. No resistance was detected to ceftriaxone and cefuroxime. All gonorrhea patients in GUM Clinic, HKL were treated with ceftriaxone, and subsequent cultures on follow-up were negative. We compared our results with the data obtained from the Gonococcal Resistance to Antimicrobials Surveillance Programme (GRASP)6 and the WHO Western Pacific Gonococcal Antimicrobial Surveillance Programme (GASP)7. Conclusion Penicillin and tetracycline resistance remain high in Malaysia and other Western Pacific countries. Resistance to ciprofloxacin was however lower in Malaysia compared to other countries. There was no resistance to ceftriaxone and cefuroxime. The current first line antibiotic for treating gonorrhoea in GUM Clinic, HKL is ceftriaxone.

Antibiotic susceptibility of neisseria gonorrhoeae isolates at the Institute of dermato-venereology, Hanoi, 1997

In the year 1997, at the National Institute of Dermato-Venerology, 2025 patients with the syndrome of vaginal and excretion underwent direct examinations and bacterial culture. Their 156 (7.7%) had positive reactions of blenorrhagy. Test of sensitivity on 156 strains of isolated gonoccoccus to antibiotics showed a rate of resistance to penicillin of 76.92%, tetracyclin 35.9%. All the isolated strains were sensitive to ceftriaxone 100%, spectinomycine 100% and 98.44% to cephalothine, 95.51% to chloramphenicol, 93.42% to ciprofloxacine. There was a PPNG rate of 64.2%

Surveillance of antibiotic resistance in neisseria gonorrhoea at the Institute of Dermato-Venereology, 2000

In the year 2000, in the Institute of Dermato-Venerology 157 of 1323 suspected patients (11.87%) were isolated from culture. By agar dispersion technique, antibiogramme showed that 47.77% were resistant to penicillin, 44.52% to tetracyclin and 42.67% to ciprofloxacine. 100% of isolated strains were well sensitive to cephalosporine of 3rd generation and to spectinomycine

Prevalence of PPNG in Seoul ( 1993 ) / 대한피부과학회지

BACKGROUND: In recent years gonorrhea has been panendemic and remains one of the most common STDs in the world, especially in developing countries. OBJECTIVE & METHOD: For the detection of a more effective teripeutic regimen and assessing the prevalence of PPNG, will have been trying to study the paieits who have visited the VD Clinic of Choong-Ku Public Health Center in Seoul since 1980 by means of the chromogenic cephalosporin method. RESULTS: In 1993, 187 strains of N. gonorrhoeae were isolated, ar, ong which 139(74.3%) were PPNG. CONCLUSION: Our results suggests that the prevalence of PPNG in Seoul is still increasing.

Treatment of Gonorrhoea

Because of increasing resistance of circulating N. gonorrhoeae and frequent failures in the treatment of gonorrhoea, intensive work on gonorrhoea has become of paramount importance. During January 1980-April 1984, at the Choong-Ku VD Clinic in Seoul, 3,340 male patients with uncomplicated gonococcal urethritis were treated with various treatment regimens. Diagnosis of gonorrhoea and declaration of a treatment failure were made on the basis of positive urethral culture. In 1984, the prevalence of Penicillinase Producing N. gonorrhoeae (PPNG) was about 30%, The pretreatment minimun inhibitory concentration of various antibiotics were quite high. Even for non-PPNG urethritis standard penicillin regimens gave unsatisfactory results. For PPNG urethritis, only spectinomycin, cefoperazone and cefotaxim-probenecid regimens gave satisfactory results. No spectmomycin resistant strain of N. gonorrhoeae has been found since 1982 at the Choong-Ku VD Clinic. As an agent of single drug therapy, spectinomycin seems to be one of the most cost effective drugs in the treatment of uncomplicated gonorrhoea in men.

Prevalence of PPNG in Seoul , Korea ( 1987 ) / 대한피부과학회지

The prevalence of PPNG among pretreatment isolates at a VD Clinic in Seoul has been studied and reported annually since 1981. In 1987, 649 strains of N. gonorrhoeae were isolated, among which 339(52.2%) were PPNGs. The prevalence of PPNG in Seoul is still increasing.

Treatment of Uncomplicated Male Gonococcal Urethritis with Clavulanate: Potentiated Amoxycillin / 대한피부과학회지

At the Venereal Disease Clinic of Choong-ku Public Health Center in Seoul ]03 male patients with uncomplicated gonococcal urethritis were allocated randomly into one of 2 treatment regimens and 101 patients were followed. All 51 patients, including PPNG infections, treated with clavulanate-potentiated amoxycillin, 375 mg, PO, t.i.d. for 5 days recovered(100%), Two(4%) of 50 patients treated with clavulanate-potentiated amoxycillin, 3. 25g, PO plus probenecid, lg, PO failed to recover. These cases were 2 of 25 Penicillinase Froducing Neisseria gonorrhoeae(PPNG) infections(failure rate of 8%) and all 25 non-PPNG infections recovered(100%). It is suggested that both of these clavulanate-potentiated amoxycillin regimens ha.ve similarly good effect with minimal side effects in the treatment of gonococcal urethritis and, because of high rate of PPNGs among circulating N, gonorrhoeae, they can be recommended as the first line treatment for gonorrhoa ir Korea.