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Introduction The threat of multidrug resistant Neisseria gonorrhoeae (NG) is a concern worldwide, especially in settings with emerging resistance to the extended spectrum cephalosporins. Since 2009 WHO recommendation to the countries to perform Antimicrobial Surveillance has been reinforced. Brazilian’s sexually transmitted infection guideline recommends dual therapy to treat gonococcal infection (ciprofloxacin plus azithromycin). However, regional studies performed in three Brazilian states demonstrated quinolone resistance. For these states it was recommended to replace the quinolones by third generation cephalosporin. The aim of this study was to perform a Brazilian national gonococcal antimicrobial surveillance. Methods The surveillance study included seven collection sites representing five geographic regions of Brazil. A total of 550 NG isolates from male urethral discharge was sent to the gonococcal national reference laboratory for analysis. The minimum inhibitory concentration (MIC) with the agar dilution method was performed for penicillin, tetracycline, ciprofloxacin, ceftriaxone, cefixime and azithromycin. Results The sensitivity profile of the NG isolates was performed in 131 isolates from the Southeast, 104 from the Northeast, 100 from the North, 68 from the Center-West and 147 from the South. In addition to penicillin and tetracycline, a high level of resistance for ciprofloxacin (47% to 78% of isolates) was observed in the isolates of all the regions. All the isolates were sensitive to ceftriaxone and cefixime, although one isolate was found with elevated MIC. Regarding azithromycin sensitivity, the majority of the isolates were sensitive, but the emergence of an intermediate (5% to 15%) or resistant (4% to 10%) profile needs to be monitored. Conclusion The national survey confirmed the high level of ciprofloxacin resistance already described worldwide. These results indicate the need to urgently change Brazilian recommendation for gonorrhoeae treatment and the importance of systematic gonococcal resistance surveillance.

Introduction The aim of this study was to determine the antimicrobial susceptibility of Neisseria gonorrhoeae isolates obtained from patients attending a public referral center for sexually transmitted diseases and specialized care services (STD/SCS) in Belo Horizonte, Brazil. Methods Between March 2011 and February 2012, 201 specimens of Neisseria gonorrhoeae were consecutively obtained from men with symptoms of urethritis and women with symptons of cervicitis or were obtained during their initial consultation. The strains were tested using the disk diffusion method, and the minimum inhibitory concentrations of azithromycin, cefixime, ceftriaxone, ciprofloxacin, chloramphenicol, penicillin, tetracycline and spectinomycin were determined using the E-test. Results The specimens were 100% sensitive to cefixime, ceftriaxone and spectinomycin and exhibited resistances of 4.5% (9/201), 21.4% (43/201), 11.9% (24/201), 22.4% (45/201) and 32.3% (65/201) to azithromycin, ciprofloxacin, chloramphenicol, penicillin and tetracycline, respectively. Intermediate sensitivities of 17.9% (36/201), 4% (8/201), 16.9% (34/201), 71.1% (143/201) and 22.9% (46/201) were observed for azithromycin, ciprofloxacin, chloramphenicol, penicillin and tetracycline, respectively. The specimens had plasmid-mediated resistance to penicillin PPNG 14.5% (29/201) and tetracycline TRNG 11.5% (23/201). Conclusions The high percentage of detected resistance to penicillin, tetracycline, chloramphenicol and ciprofloxacin indicates that these antibiotics are not appropriate for gonorrhea treatment at the Health Clinic and possibly in Belo Horizonte. The resistance and intermediate sensitivity of these isolates indicates that caution is recommended in the use of azithromycin and emphasizes the need to establish mechanisms for the surveillance of antimicrobial resistance for the effective control of gonorrhea.