ABSTRACT
A study was carried out in a rural district of Malawi among men presenting with urethral discharge, in order to a) describe their health seeking and sexual behaviour b) determine the prevalence of Neisseria gonorrhoeae (N.gonorrhoeae) and Chlamydia trachomatis (C.trachomatis), and c) verify the antibiotic susceptibility of N.gonorrhoeae. A total of 114 patients were entered into the study. 61% of study subjects reported having taken some form of medication before coming to the Sexually Transmitted Infections (STI) clinic. The most frequent alternative source of care was the traditional healer. 68 (60%) patients reported sex during the symptomatic period the majority (84%) not using condoms. Using ligase chain reaction on urine, N.gonorrhoeae was detected in 91 (80%) and C.trachomatis in 2 (2%) of urine specimens. 45 of 47 N.gonorrhoeae isolates produced penicillinase, 89% showing multi-anti-microbial resistance. This study emphasises the need to integrate alternative care providers and particularly traditional healers in STI control activities and to encourage their role in promoting safer sexual behaviour. In patients presenting with urethral discharge in our rural setting, C.trachomatis was not found to be a major pathogen. Antimicrobial susceptibility surveillance of N.gonorrhoeae is essential in order to prevent treatment failures and control the spread of resistant strains.
ABSTRACT
A study was carried out in 2000/2001 in a rural district of Malawi among men presenting with urethral discharge, in order to (a) describe their health-seeking and sexual behaviour, (b) determine the prevalence of Neisseria gonorrhoeae and Chlamydia trachomatis, and (c) verify the antibiotic susceptibility of N. gonorrhoeae. A total of 114 patients were entered into the study; 61% reported having taken some form of medication before coming to the sexually transmitted infections clinic. The most frequent alternative source of care was traditional healers. Sixty-eight (60%) patients reported sexual encounters during the symptomatic period, the majority (84%) not using condoms. Using ligase chain reaction on urine, N. gonorrhoeae was detected in 91 (80%) and C. trachomatis in 2 (2%) urine specimens. Forty five of 47 N. gonorrhoeae isolates produced penicillinase, 89% showing multi-antimicrobial resistance. This study emphasizes the need to integrate alternative care providers and particularly traditional healers in control activities, and to encourage their role in promoting safer sexual behaviour. In patients presenting with urethral discharge in our rural setting, C. trachomatis was not found to be a major pathogen. Antimicrobial susceptibility surveillance of N. gonorrhoeae is essential in order to prevent treatment failures and control the spread of resistant strains.
Subject(s)
Chlamydia Infections/psychology , Chlamydia trachomatis , Sexual Behavior , Urethritis/microbiology , Adolescent , Adult , Chlamydia Infections/drug therapy , Chlamydia Infections/epidemiology , Condoms/statistics & numerical data , Drug Resistance, Bacterial , Gentamicins/therapeutic use , Gonorrhea/drug therapy , Gonorrhea/epidemiology , Humans , Malawi/epidemiology , Male , Middle Aged , Patient Acceptance of Health Care/statistics & numerical data , Prevalence , Rural Health , Tetracycline ResistanceABSTRACT
The cumulative cholera attack rate in an epidemic in Malawi in 1999/2000 was 59/100,000 population, case-fatality rate 4%, and 98% of all cases presenting to health facilities required intravenous therapy. Microbiological studies showed high resistance of Vibrio cholerae to commonly recommended antibiotics, predominant Ogawa serotypes and no O139 isolates.
