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Establishment of a gonococcal antimicrobial surveillance programme (GASP), in accordance with WHO standards, in Côte d'Ivoire, Western Africa, 2014-2017.

BACKGROUND: Antimicrobial resistance (AMR) in Neisseria gonorrhoeae is compromising the treatment of gonorrhea globally. Recent AMR data are extremely limited in Africa, and mainly totally lacking in Western Africa including Côte d'Ivoire. This study i) established a quality-assured gonococcal antimicrobial surveillance programme (GASP), according to WHO quality criteria, ii) investigated the AMR to eight therapeutic antimicrobials in gonococcal isolates from 2014 to 2017, and iii) provided evidence for updating the national STD syndromic management guidelines in Côte d'Ivoire.

METHODS: During 2014-2017, gonococcal isolates were obtained from sexually active symptomatic or asymptomatic males and females in 14 sites in Côte d'Ivoire. It was a special focus on symptomatic males, and their sexual partners, due to the higher culture positivity rates in symptomatic males. Patient metadata were collected, including age, gender, sexual orientation and symptoms. Minimum inhibitory concentrations (MICs) of eight antimicrobials were determined by Etest and interpreted using EUCAST breakpoints. β-lactamase production was detected using cefinase disks.

RESULTS: The level of resistance, examining 212 gonococcal isolates, was as follows: 84.9% to tetracycline, 68.9% to benzylpenicillin, 62.7% to ciprofloxacin, 6.1% to azithromycin, and 1.4% to gentamicin. All isolates were susceptible to ceftriaxone, cefixime and spectinomycin.

CONCLUSION: We provide the first gonococcal AMR data, quality assured according to WHO standards, from Côte d'Ivoire since more than 20 years. The high ciprofloxacin resistance, which informed a revision of the national syndromic management guideline during study, and relatively high resistance to azithromycin demand an improved GASP and increased awareness when prescribing treatment in Côte d'Ivoire.

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