Genotypes and antimicrobial-resistant phenotypes of Neisseria gonorrhoeae in Portugal (2004-2009).

OBJECTIVES: To determine the antibiotic phenotype and MAST-genotype distribution of Neisseria gonorrhoeae isolates in Portugal between 2004 and 2009, and to evaluate specific associations between MAST-genotypes and sexual orientation, age and antibiotic resistance. METHODS: A total of 236 N gonorrhoeae isolates were typed through N gonorrhoeae multiantigen sequence typing (NG-MAST). The degree of polymorphism and the phylogenetic relatedness among NG-MAST sequence types (STs) were evaluated with MEGA4 software on concatenated sequences of por and tbpb alleles. Etest was used to determine the susceptibility to ceftriaxone, ciprofloxacin, penicillin and spectinomycin. RESULTS: No isolates displayed resistance to spectinomycin and ceftriaxone, whereas 79.1% and 37.4% were resistant to penicillin and ciprofloxacin, respectively. A total of 104 different STs (one per 2.3 isolates) were found; the most common were ST210 (8.1%) and ST225 (7.6%). STs formed two major groups separated by 159.8 (SE 8.9) nucleotide differences, yielding several subgroups, one of them including the worldwide-prevalent ST225. The probability of ciprofloxacin resistance among isolates within this subgroup was 73.5-fold higher than for the remaining isolates. Indeed, for the genetically closest subgroup, which includes the most prevalent ST (ST210), only 8.0% of isolates were resistant to ciprofloxacin. There was a non-homogeneous distribution per year for ST225 (p<0.001), ST210 (p=0.011) and ST2 (p=0.007). CONCLUSIONS: The heterogeneous ST scenario may represent the 'tip of the iceberg', reflecting a high number of undiagnosed and unreported gonorrhoea cases. A laboratory-based national surveillance of N gonorrhoeae infections is necessary to provide a broader spectrum of isolates that will allow the sexual network situation in Portugal to be established.

Genital infection by Chlamydia trachomatis in Lisbon: prevalence and risk markers.

BACKGROUND: There is little information about the prevalence and risk markers for Chlamydia trachomatis infections in Portugal. OBJECTIVES: Our aim was to assess the prevalence of C. trachomatis genital infection and to study variables associated with this infection in a group of sexually active women aged < or =30 years living in the Lisbon area and to estimate the prevalence of C. trachomatis infection among partners of infected patients. METHODS: A systematic sample of women observed in general practice family planning and teenager clinics was collected. A questionnaire was administered, followed by a pelvic examination. A first-catch urine sample was taken for polymerase chain reaction (PCR) Amplicor assay. When a sample tested positive, the woman was invited to obtain a urine sample from her partner. Socio-demograhic, behavioural and clinical variables were studied and their association with the PCR Amplicor result was assessed. RESULTS: A total of 1108 women, aged between 14 and 30 years, were studied. Fifty-one women (4.6% of total sample) tested positive for C. trachomatis. The prevalence of infection was slightly higher in patients aged < or =19 years (5.3%) than in age groups 20-25 (4.8%) and 26-30 years (3.9%). African ethnicity was related to a higher percentage of infection than European ethnicity: 9.8% versus 3.8%, P= 0.0067. Use of condoms "sometimes/never" was associated with a higher prevalence of infection: 5.2% versus 2.3% in those responding "always/almost always" (P= 0.0447). An altered cervix was associated with a higher prevalence of infection: 7.3% versus 3.7% with a normal cervix (P= 0.0106). Urine samples were obtained from 16 partners of infected patients. Six partners (37.5%) tested positive for C. trachomatis. CONCLUSIONS: A 4.6% prevalence of C. trachomatis genital infection was found. African ethnicity, using condoms "sometimes/never" and an altered cervix were associated with C. trachomatis infection, but showed low positive predictive value for C. trachomatis infection. Younger age may be associated with a slight increase in risk. Contact tracing for diagnosis and treatment remains a difficult issue to approach effectively.