Antimicrobial resistance and clinical aspects in anorectal Neisseria gonorrhoeae in a hospital in CABA, Argentina
Keywords:
gonorrhea - proctitis - antimicrobial resistance - sexually trasmitted infections - HIV - Men Who Have Sex With Men - anal sex
Abstract
Neisseria gonorrhoeae (NG) infection is considered a high public health priority because of its ability to develop resistance to most of the antibiotics used to treat it.
The anorectal presentation is generally asymptomatic and frequent in men who have sex with men (MSM). In Argentina, dual therapy (ceftriaxone+azithromycin/doxycycline) is recommended as first line empiric therapy.
This observational and retrospective study was conducted to evaluate the percentage of anorectal NG positivity, the susceptibility profile to penicillin, tetracycline, ciprofloxacin, ceftriaxone, cefixime and azithromycin, as well as the clinical-epidemiological aspects of patients attended between 20/10/2015 and 20/03/2020 in coloproctology of a public hospital.
We detected 55/436 positive rectal swabs for NG (13%). 95% were MSM and 71% were PLHIV. In 18/55 NG was the only infection. The most frequent co-infections: HPV (38%) and C. trachomatis (35%).
Susceptibility to extended-spectrum cephalosporins (ESCs) and azithromycin was 100% and 98%, respectively. Local emergence of the first five anorectal NG isolates with decreased susceptibility (DS) to ESCs, the first isolate with nonsusceptible category to azithromycin and another with DS to azithromycin concomitantly with DS to ESCs were observed.
Although the use of dual empirical therapy continues to be adequate for our institution, the emergence of isolates with DS and NS to first-line drugs was observed, evidencing the importance of epidemiological surveillance at the local level to define empirical treatments
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References
Referencias
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23. Allan–Blitz LT, Leon SR, Bristow CC, Konda KA, Vargas SK, Flores JA et al. High prevalence of extra-genital chlamydial or gonococcal infections among men who have sex with men and transgender women in Lima, Peru. Int J STD AIDS 2017;28(2):138
24. La Rosa L, Svidler López L, Entrocassi AC, et al. Chlamydia trachomatis anorectal infections by LGV (L1, L2 and L2b) and non-LGV serotypes in symptomatic patients in Buenos Aires, Argentina. Int J STD AIDS. 2021 Dec; 32(14):1318-1325.
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1. WHO. Global progress report on HIV, viral hepatitis and sexually transmitted infections, 2021. May 20, 2021.
2. Workowski KA. Sexually Transmitted Infections and HIV: Diagnosis and Treatment. Top Antivir Med. 2012; 20: 11-16.
3. Bernstein KT, Marcus JL, Nieri G, et al. Rectal gonorrhea and chlamydia reinfection is associated with increased risk of HIV seroconversion. Journal of Acquired Immune Deficiency Syndromes 2010; 53: 537-43.
4. World Health Organization (WHO). Global action plan to control the spread and impact of antimicrobial resistance in Neisseria gonorrhoeae. World Health Organization (WHO), Department of Reproductive Health and Research. 2012; 1: 1-36.
5. Kidd S, Zaidi A, Asbel L, Baldwin T, Gratzer B, Guerry S et al. Comparison of antimicrobial susceptibilities of pharyngeal, rectal, and urethral Neisseria gonorrhoeae isolates among men who have sex with men. 2015 Antimicrob Agents Chemother 2015 59:2588–2595.
6. Patton ME, Kidd S, Llata E, Stenger M, Braxton J, Asbel L et al. Extragenital gonorrhea and chlamydia testing and infection among men who have sex with men–STD Surveillance Network, United States, 2010–2012. Clin Infect Dis 2014. 58:1564–1570.
7. Dukers-Muijrers NH, Schachter J, van Liere GA, Wolffs PF and Hoebe CJ. What is needed to guide testing for anorectal and pharyngeal Chlamydia trachomatis and Neisseria gonorrhoeae in women and men? Evidence and opinion. BMC Infectious Diseases. 2015; 15: 1-13.
8. Comunicado de prensa OMS. El aumento de la gonorrea resistente a los antibióticos hace necesarios nuevos fármacos. Ginebra, 7 de julio de 2017.
9. Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance 2017: Gonococcal Isolate Surveillance Project (GISP) Supplement and Profiles. Atlanta: U.S. Department of Health and Human Services; 2019.
10. Wi T, Lahra MM, Ndowa F, Bala M, Dillon J-AR, Ramon-Pardo P, et al. (2017) Antimicrobial resistance in Neisseria gonorrhoeae: Global surveillance and a call for international collaborative action. PLoS Med 14(7): e1002344.
11. Organización Mundial de la Salud. WHO guidelines for the treatment of Neisseria gonorrhoeae.Ginebra: OMS; 2016.
12. Magnus Unemo, Monica M. Lahra, Michelle Cole, Patricia Galarza, Francis Ndowa, Irene Martin et al. World Health Organization Global Gonococcal Antimicrobial Surveillance Program (WHO GASP): review of new data and evidence to inform international collaborative actions and research efforts. Sex Health. 2019 September; 16(5): 412–425.
13. St. Cyr S, Barbee L, Workowski KA, et al. Update to CDC’s Treatment Guidelines for Gonococcal Infection, 2020. MMWR Morb Mortal Wkly Rep 2020; 69: 1911–1916.
14. Helen Fifer, John Saunders, Suneeta Soni, S Tariq Sadiq and Mark FitzGerald. 2018 UK national guideline for the management of infection with Neisseria gonorrhoeae. International Journal of STD & AIDS 2020, Vol. 31(1) 4–15
15. Gianecini R, Oviedo C, Bardossy E, Galarza P. Evaluation of antimicrobial susceptibility and resistance in Neisseria gonorrhoeae, Argentina, 2009–2013. In: Abstracts of the Interscience Conference on Antimicrobial Agents and Chemotherapy/International Congress of Chemotherapy, San Diego, Sep 17–21, 2015. Washington (DC): American Society for Microbiology; 2015. Abstract C-672.
16. Gianecini R, Oviedo C, Stafforini G, Galarza P. Neisseria gonorrhoeae resistant to ceftriaxona and cefixima, Argentina. Letter to the Editor. Emerging Infectious diseases. Vol22, Nro. 6, June 2016.
17. Instituto Nacional de Enfermedades Infecciosas (INEI). Servicio Transmisión Sexual. Incremento y reemergencia de aislamiento de Neisseria gonorrhoeae con baja y alta resistencia a la azitromicina en Argentina. Ciudad Autónoma de Buenos: ANLIS Dr. C. G Carlos Malbrán, 2020.
18. Recomendaciones de diagnóstico y tratamiento de las Infecciones de Transmisión Sexual de la Comisión de HIV/SIDA y de ITS de la Sociedad Argentina de Infectología. Año 2020.
19. López L. et al. Manifestaciones Coloproctológicas de las Infecciones de Transmisión Sexual Ocasionadas por Chlamydia Trachomatis, Neisseria Gonorrhoeae y Treponema Pallidum. Presentación Casuística. Svidler REV ARGENT COLOPROCT | 2019 | VOL. 30, N° 4: 80-87
20. Kirkcaldy RD, Weston E, Segurado AC, Hughes G. Epidemiology of gonorrhoea: a global perspective. Sex Health. 2019 Sep; 16(5):401-411.
21. Michelle L. Johnson Jones, Johanna Chapin-Bardales, Destani Bizune, John R. Papp, Christi Phillips, Robert D. Kirkcaldy et al. Extragenital Chlamydia and Gonorrhea Among Community Venue–Attending Men Who Have Sex with Men-Five Cities, United States, 2017. Morbidity and Mortality Weekly Report. Weekly / Vol. 68 / No. 14. April 12, 2019.
22. Yang L-G, Zhang X-H, Zhao P-Z, Chen Z-Y, Ke W-J, Ren X-Q. Gonorrhea and chlamydia prevalence in different anatomical sites among men who have sex with men: a cross-sectional study in Guangzhou, China. BMC Infect Dis 2018; 18(1):675.
23. Allan–Blitz LT, Leon SR, Bristow CC, Konda KA, Vargas SK, Flores JA et al. High prevalence of extra-genital chlamydial or gonococcal infections among men who have sex with men and transgender women in Lima, Peru. Int J STD AIDS 2017;28(2):138
24. La Rosa L, Svidler López L, Entrocassi AC, et al. Chlamydia trachomatis anorectal infections by LGV (L1, L2 and L2b) and non-LGV serotypes in symptomatic patients in Buenos Aires, Argentina. Int J STD AIDS. 2021 Dec; 32(14):1318-1325.
25. Ministerio de Salud. Presidencia de la Nación. Alerta epidemiológica: Casos de linfogranuloma venéreo (LGV) en Argentina. 2018.
26. Magnus Unemo, H Steven Seifert, Edward W. Hook III, Sarah Hawkes, Francis Ndowa, Jo- Anne R. Dillon. WHO global antimicrobial resistance surveillance for Neisseria gonorrhoeae 2017–18: a retrospective observational study. Lancet Microbe 2021.
27. United States Food and Drug Administration. Nucleic Acid Based Tests.https://www.fda.gov/medicaldevices/vitro-diagnostics/nucleic-acid-based-tests (2019).
Published
2024-04-07
How to Cite
Scocozza, L., Errecalde, L., Montibello, S., Sidra, G. L., Cipollone, S., Cabrini, M., Rolón, M. J., Gianecini, R. A., Oviedo, C., Galarza, P., & Svidler López, L. (2024). Antimicrobial resistance and clinical aspects in anorectal Neisseria gonorrhoeae in a hospital in CABA, Argentina. Actualizaciones En Sida E Infectología, 32(114). https://doi.org/10.52226/revista.v32i114.222
Section
Original article
