Ciprofloxacin resistant gonorrhoea increasing in South Africa

The antibiotic ciprofloxacin should not remain the first-line treatment for gonorrhoea in Durban, South Africa, because of increasing resistance to the drug, according to a letter in this week's issue of The Lancet. The South African Department of Health should also move rapdily to investigate the scale of the problem throughout South Africa, say researchers from the University of Kwazulu Natal.

A survey at Prince Cyril Zulu Centre for Communicable Diseases in Durban in January 2005 showed that 42% of men with urethritis had ciprofloxacin-resistant gonnorrhoea, compared with 23% of isolates in January 2003.

All gonorrhoea isolates had remained sensitive to ciprofloxacin until 2002.

However, reports of treatment failure appeared in November 2003 and coincided with the appearance of ciprofloxacin-resistant N gonorrhoea isolates at a prevalence of 22%. Further reports of drug resistance have continued and have been reported to the Department of Health. However, ciprofloxacin has remained the first-line agent in the syndromic management package for genital discharge caused by the infection.

“Postponing effective treatment in an area with a high prevalence of HIV and N gonorrhoea has obvious implications in terms of the transmission of both organisms”, say the authors. “The initial inappropriate treatment resulted in preferential transmission of the resistant organisms. Non-responding gonococcal disease increases the duration of mucosal inflammation, which in turn increases the likelihood of HIV transmission.”

They call for urgent revision of the syndromic management guidelines for gonorrhoea in Kwazulu Natal.