Study of antimicrobial sensitivity pattern of neisseria gonorrhoeae.

INTRODUCTION : Sexually transmitted diseases are prevalent through out the world. About 340 million new cases reported every year. Incidence of new STD cases per year in India is about 40 million or 5% of population. Globally around 39.4 million person are living with HIV/AIDS, and India has 5.13million HIV infections.1 Sexually transmitted diseases (STD) play a major role in the transmission of HIV infection. Thus prevention and control of STD is one of the major strategies for the control of HIV. STD can be grouped as ulcerative and non-ulcerative. The risk of acquiring HIV infection in ulcerative STD is 5 to 7 times and in non ulcerative STD to 3 to 5 times more than that in persons without any sexually transmitted infections. Since the prevalence of non-ulcerative STD is higher than ulcerative STD, it represents the population at attributable risk in the transmission of HIV. One of the main non- ulcerative STD is Gonorrhoea. The relative incidence of gonococcal infections is about 10 to 13% of total sexually transmitted infections in STD clinics. Common symptoms are urethritis in male and cervicitis is female. HIV positive men with urethritis had HIV concentrations in the semen more than those in seropositive men without urethritis. After treatment of urethritis the concentrations of HIV in semen decreased significantly. Causative organism for gonorrhoea is Neisseria gonorrhoeae. Man being the only natural host. N. gonorrhoeae usually produces purulent exudates, but signs and symptoms of the disease may be absent especially in women or indistinguishable from those of Chlamydial infection. Therefore, laboratory procedures are needed for the diagnosis. In recent years, there has been an alarming increase in ciprofloxacin and penicillin-resistant N. gonorrhoeae in India. Establishing appropriate treatment strategies is further complicated by the rapidly changing resistance patterns. Hence monitoring of drug resistance patterns at regular intervals, is essential. AIMS AND OBJECTIVES : 1. To identify the gonococcal infection in patients attending the STD clinic. 2. To study the antimicrobial susceptibility of gonococcus. 3. To study the prevalence of Penicillinase producing N. gonorrhoeae. 4. To study the associated sexually transmitted infections. 5. To modify the disease intervention activities and therapy recommendations accordingly. PURPOSE OF THE STUDY : The knowledge of the prevalence of antibiotic resistant strains is essential for instituting disease control and preventive measures. In India we do not have enough data about the prevalence of antibiotic resistant strains. Efforts are being made to widen the SEAR GASP (South East Asia Region Gonococcal Antimicrobial surveillance programme) network in India. Treatment recommendations has to be changed depending upon the surveillance data. WHO no longer recommends a single, first line treatment for gonorrhoea. Instead each nation must make decisions according to its own resistance situation as resistance levels vary from one nation to the next indeed from clinic to clinic. CONCLUSION : 1. The results of the study indicate that multidrug resistant Neisseria gonorrhoeae is prevalent in this region. 2. The value of Penicillin and Ciprofloxacin as drugs for the treatment of Gonorrhoea is doubtful as all the strains were either less sensitive or resistant to these drugs. 3. Azithromycin looks promising with no drug resistance. 4 Associated STDs has to be investigated to prevent the transmission of HIV and further complications. 5. Need for establishing a national surveillance programme for antibiotic resistance becomes clear