Neisseria gonorrhoeae

In Africa, sexually transmitted infections (STIs) have a major impact on health including adverse consequences that are exacerbated by structurally deficient health-care systems (Buve et al. 2001; Gerbase et al. 1998; Mullick et al. 2005). Before the era of antibiotics, invasive STIs invariably progressed to long-term complications, a situation that remains for sexually transmitted diseases of viral etiology. Introduction of cheap but effective antimicrobials substantially reduced mortality and spread of sexually transmitted diseases like chlamydial infections, syphilis, and gonorrhea. For many bacterial STIs, penicillins and tetracycline were commonly used for treatment in developing countries until they were challenged by the appearance of plasmid-mediated resistance in N. gonorrhoeae strains from geographically diverse areas of Tanzania (West et al. 1995), Zimbabwe (Mason and Gwanzura 1988), Ghana (Addy 1994), Ethiopia (Habte-Gabr et al. 1983) and Nigeria (Obaseiki-Ebor et al. 1985). Limited data obtainable from Africa suggest that chlamydial infections and syphilis are still responding to these treatments (Tapsall 2005).

Increasing resistance to penicillins and tetracycline required changes in STI treatment protocols, introducing drugs like trimethoprim-sulfamethoxazole, gentamicin, kanamycin, and thiamphenicol in many parts of Africa. In the last two decades, newer, more expensive therapies, including ceftriaxone, ciprofloxacin, and spectinomycin, were also recommended for the treatment of gonorrhea (Tapsall 2001). In spite of their apparent, if temporary, success it is pertinent to note that most of these drugs are too expensive for patients in growing economies where a substantial part of the problem resides. Strains of N. gonorrhoeae that are less susceptible to even these newer antimicrobials have already been reported in South Africa (Moodley et al. 2004), Djibouti (Haberberger et al. 1990), and Tanzania (West et al. 1995). These observations indicate that N. gonorrhoeae is becoming resistant to increasing number of antibiotics and strongly suggest that even expensive antibiotics may soon cease to be sufficiently effective in the treatment of gonococcal disease (Tapsall 2005).

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