Introduction: Neisseria gonorrhoeae is evolving into a superbug with resistance to previously and currently recommended antimicrobials, which is a major public health concern globally. The high rate of usage of antimicrobials, less control and monitoring of antimicrobial resistance (AMR) surveillance, slow update of treatment guidelines in most geographical settings, and the extraordinary capacity of the gonococci to develop and retain antimicrobial resistance lead the bacterium to be untreatable in the near future. This study aimed to determine the antimicrobial susceptibility pattern of Neisseria gonorrhoeae, and clinical profiles of suspected sexually transmitted infections in Addis Ababa City, Ethiopia.
Methods: Health institutional-based cross-sectional study was conducted from April 2023 to December 2024 in five health centers located in Addis Ababa. A convenient sampling method was used to collect endocervical and urethral sample swabs from 571 study subjects. Samples were cultured onto Thayer Martin Luther agar, and Gram staining and biochemical tests were used to confirm the presence of gonococci. Antimicrobial susceptibility pattern was done using disk diffusion methods, and interpretation was done accordingly.
Results: Of the 571 study subjects, 488 (85%) had discharge, 472 (82.7%) had painful urination, and 339 (59.4%) had pelvic pain. The prevalence of N. gonorrhoeae among STI patients was 17.33%. N. gonorrhoeae isolates showed high resistance to tetracycline (96 %), and penicillin (91%), ciprofloxacin (69.7 %), and they were sensitive to azithromycin (76.8 %), cefixime (89.9 %), and ceftriaxone (91.9 %). The resistance patterns of gonococcal isolates ranged from 8.10 % to 96.0 % for ceftriaxone and tetracycline, respectively. The multidrug resistance of N. gonorrhoeae was encountered in 33 (33.3%) isolates, whereas 8 (8.08%) showed extensive drug resistance.
Conclusion: The high prevalence of N. gonorrhoeae reported in the health centers of Addis Ababa requires an urgent need for strengthened surveillance and community interventions. In addition to the isolates exhibiting resistance to penicillin and tetracycline, multidrug resistance was reported, and no isolates were sensitive to any of the test antibiotics. The need for enhanced treatment protocols and integrated services of STD and HIV are discussed.