Gonorrhea surveillance in Ghana, Africa

We face the specter of global transmission of highly resistant Neisseria gonorrhoeae. The U.S. Department of Defense's Armed Forces Health Surveillance Center has engaged many military and civilian partners (including Ghana) in a sexually transmitted infections (STI) program to address emerging needs in STI surveillance. We implemented gonorrhea surveillance in Ghana to fill the gap in knowledge regarding gonorrhea prevalence and antimicrobial resistance characterization in Ghana.

Gonorrhea surveillance was conducted from June 2012 to March 2013 as one of the AFHSC surveillance network partners at two Ghana Armed Forces (GAF) military clinics. The population encompassed a convenience sampling of patients presenting with STI symptoms. Urine was taken for nucleic acid amplification testing (NAAT). A urethral or cervical/vaginal specimen was obtained for culture and antibiotic susceptibility testing.

13/220 (6%) specimens tested were positive by culture (7 of which were confirmed); and 39/213 (18%) specimens tested were positive by NAAT. Positive results were biased toward men. Cultures were resistant to ciprofloxacin, penicillin and tetracycline and sensitive to cephalosporins.

This investigation provides data on gonorrhea prevalence and resistance profiles in Ghana hitherto poorly characterized. We note significant resistance to fluoroquinolones without the presence of resistance yet to the cephalosporins.