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  • Title: Epidemic spread of plasmid-mediated tetracycline resistant Neisseria gonorrhoeae in Zaire.
    Author: Van Dyck E, Laga M, Manoka AT, Behets F, Piot P.
    Journal: Int J STD AIDS; 1995; 6(5):345-7. PubMed ID: 8547415.
    Abstract:
    A cohort of 650 prostitutes from Kinshasa, Zaire, was followed at monthly intervals for sexually transmitted diseases as part of an HIV intervention project. Neisseria gonorrhoeae isolates, obtained during a period of 30 months, were auxotyped, serotyped and tested for antimicrobial susceptibility. Among 1085 gonococcal isolates tested, 725 (67%) produced beta-lactamase (PPNG) and 323 (30%) showed plasmid-mediated resistance to tetracyline (TRNG). Over time, the prevalence of PPNG varied between 60 and 73%, while the level of TRNG increased from 11 to 45%. During May 1988-October 1990 in Zaire, Neisseria gonorrhoeae isolates were obtained from 650 initially HIV-negative prostitutes in Kinshasa who were followed monthly for 30 months. After conservation of the gonococci, the N. gonorrhoeae isolates were then transported to the Institute of Tropical Medicine in Antwerp, Belgium, to test for antimicrobial resistance, especially tetracycline resistant isolates of N. gonorrhoeae. Among the 1085 isolates, 67% were resistant to penicillin (i.e., penicillinase producing N. gonorrhoeae [PPNG]). 30% exhibited plasmid-mediated resistance to tetracycline (TRNG). 37% were resistant to thiamphenicol. Thiamphenicol resistance was more common in non-TRNG isolates than TRNG isolates (49% vs. 8%; p 0.0001). The frequency of TRNG among PPNG isolates was higher than it was among non-PPNG isolates (37% vs. 16%; p 0.001). PPNG prevalence ranged from 60% to 73%. TRNG prevalence increased steadily from 11% to 45% during the 30-month period. Both TRNG and PPNG isolates were significantly associated with the auxotype/serovar class Pro-/IA-6 (p 0.0001 and p = 0.0002, respectively). They were also associated with growth inhibition by 0.25 mM phenylalanine (p 0.0001 and p = 0.001, respectively). The number of different TRNG auxotype/serovar classes ranged from 6 to 13. It has been suggested that tetracycline use to control gonorrhea in the US and in the Netherlands increased the frequency and spread of TRNG. Only spectinomycin and ciprofloxacin were used to treat gonorrhea in this study. Yet, tetracycline was prescribed for genital Chlamydia trachomatis infection, which many of the prostitutes had. Also, males self-medicate for urethritis with tetracycline. Populations with a high incidence of gonococcal infections may experience an epidemic spread of TRNG.
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