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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.

A gonorreia, ainda hoje, continua a representar grande preocupação para a saúde pública, com graves consequências, especialmente para mulheres e crianças. Ocorrem anualmente 106 milhões de novos casos de gonorreia no mundo. Seu controle tem sido difícil na maioria das populações, e permanece como exemplo da influência de fatores sociais, comportamentais e demográficos, sobre a epidemiologia da doença infecciosa. A terapêutica da gonorreia tem sofrido modificações, impostas por alterações na estrutura molecular do gonococo, mediadas por cromossomos ou plasmídeos, que lhe confere a capacidade de resistir à ação de vários antimicrobianos, como penicilinas, tetraciclinas, macrolídeos, fluoroquinolonas, tianfenicol, espectinomicina e, recentemente, às cefalosporinas. O conhecimento dos padrões de sensibilidade loco-regionais da Neisseria gonorrhoeae é essencial para se estabelecer a melhor forma de tratamento. A gonococcia exige vigilância contínua em relação à emergência de resistência da N. gonorrhoeae, no entanto, são raros os estudos sobre o tema no Brasil. Neste trabalho, buscou-se avaliar a susceptibilidade a antimicrobianos da N. gonohrroea isolada de pacientes atendidos no serviço de referência para doenças sexualmente transmissíveis e infectologia (DST/SAE), Unidade de Referência Secundária Centro-Sul, da Secretaria Municipal de Saúde (URS-CS/SMSA) de Belo Horizonte; determinar a frequência de gonorreia nesta unidade de saúde e determinar as características socio-demográficas dos pacientes atendidos em relação a idade, sexo, renda, local de residência, escolaridade, número de parceiros sexuais, passado de doença sexualmente transmissível e uso de preservativos. Entre março de 2011 e fevereiro de 2012 foram obtidos, de modo consecutivo, 201 isolados de Neisseria gonorrhoeae de homens com sintomatologia de uretrite e mulheres com sintomatologia de cervicite ou em primeira consulta. Após a identificação confirmatória do microrganismo, as cepas foram testadas por difusão em disco e a concentração inibitória mínima determinada por Etest para azitromicina, cefixima, ceftriaxona, ciprofloxacina, cloranfenicol, penicilina, tetraciclina e espectinomicina. Foram realizadas sorologias para hepatites B e C, vírus da imunodeficiência humana, sífilis e microscopias para diagnóstico de outras DST. Foram obtidas informações sócio-demográficas e comportamentais dos pacientes por meio de questionário e consulta aos prontuários médicos. Foi observada sensibilidade de 100% dos isolados para cefixima, ceftriaxona e espectinomicina. A resistência observada foi de 4,5% (9/201); 21,4% (43/201); 11,9% (24/201); 22,4% (45/201); e 32,3% (65/201) à azitromicina; ciprofloxacina; cloranfenicol; penicilina e tetraciclina, respectivamente. Sensibilidade reduzida foi detectada em 17,9% (36/201); 4,0% (8/201); 16,9% (34/201); 71,1% (143/201) e 22,9% (46/201) à azitromicina; ciprofloxacina; cloranfenicol; penicilina e tetraciclina, respectivamente. Foram classificadas como resistência mediada por plasmídeos a penicilina (PPNG) 14,5% (29/201), e tetraciclina (TRNG) 11,5% (23/201). Os elevados percentuais de resistência detectados para penicilina, tetraciclina, ciprofloxacina e cloranfenicol os tornam inadequados ao tratamento de gonorreia na Unidade de Saúde e, possivelmente, em Belo Horizonte. Os índices de resistência e sensibilidade reduzida recomendam cautela na utilização da azitromicina, além de enfatizarem a necessidade de se estabelecer mecanismos de vigilância da resistência a antimicrobianos para controle efetivo da gonorreia. Gonorrhea, even today, continues to represent a big public health concern, with serious consequences, especially for women and children. Occur each year 106 million new cases of gonorrhea in the world. Its control has been difficult in most populations, and it remains as an example of the influence of social, behavioral and demographic factors about the epidemiology of the infectious disease. The treatment of gonorrhea has passed through modifications imposed by changes in the molecular structure of the gonococcus, mediated by chromosomes or plasmids, which gives it the ability to resist to the action of various antibiotics, such as penicillins, tetracyclines, macrolides, quinolones, thiamphenicol, spectinomycin, and recently, cephalosporins. The knowledge of local Neisseria gonorrhoeae susceptibility patterns is essential to establish the best treatment. The gonococcal infection resistance requires a quality continuous surveillance, however few studies on this topic have been conducted in Brazil. In this study, was sought the evaluation of the antimicrobial susceptibility of N. Gonohrroea isolated from patients treated at the service of reference for sexually transmitted diseases and infectology (STD / SAE) - Center-South Secondary Reference Unity, of the Municipal Health Secretary (URS-CS/SMSA) of Belo Horizonte; determine the frequency of gonorrhea in the health unit and to determine the socio-demographic characteristics of the patient attended in the service in relation to age, gender, income, place of residence, education, number of sex partners, historic of sexually transmitted disease and condom use. Between 2011 March and 2012 February were obtained consecutively, 201 Neisseria gonorrhoeae isolates in men with symptoms of urethritis and symptomatic women or in initial consultation. After confirmatory identification of microorganism strains were tested by disk diffusion and minimum inhibitory concentration determined by Etest to azithromycin, cefixime, ceftriaxone, ciprofloxacin, chloramphenicol, penicillin, tetracycline and spectinomycin. Were performed serologies for hepatitis B and C, human immunodeficiency virus, syphilis and microscopies for the diagnosis of other STDs. Information was obtained on socio-demographic and behavioral characteristics of patients using a questionnaire and medical records. It was observed sensitivity of 100,0% of the isolates to cefixime, ceftriaxone and spectinomycin. The observed resistance was 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. Reduced sensitivity was observed in 17.9% (36/201), 4.0% (8/201), 16.9% (34/201), 71.1% (143/201) and 22.9% (46/201) to azithromycin, ciprofloxacin, chloramphenicol, penicillin and tetracycline, respectively. Them were classified as plasmid-mediated resistance to penicilin(PPNG) 14.5% (29/201), and tetracycline (TRNG) 9.5% (19/201). The high resistance detected percentage to penicillin, tetracycline, ciprofloxacin and chloramphenicol make them unsuited to the treatment of gonorrhea in the Health Unit, and possibly in all Belo Horizonte. The rates of resistance and reduced susceptibility recommend caution in the use of azithromycin, besides emphasizing the need of establish mechanisms for surveillance of antimicrobial resistance for effective control of gonorrhea.

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.