Background
Resistance patterns in Neisseria gonorrhoeae are critical for treatment guidelines. During routine diagnostic activities, we observed an abnormal frequency in isolation of Neisseria gonorrhoeae and decreases in antibiotic susceptibility.
Aim/Methods
We aim to characterized temporal trends in susceptibility to azithromycin, fluoroquinolones, and cephalosporins in isolates from clinical specimens at the “Institut national d’hygiène” in Lome from 2010-2026. We analyzed the reports of bacteriological examinations of samples received at the bacteriology laboratory. Antibiotic susceptibility testing was performed following the diffusion in agar medium method, E-test methods and Vitek-compact methods according to the standards of the antibiogram committee of the French society of microbiology / EUCAST. Annual susceptibility rates and 95% confidence intervals were calculated, compared and tested using Epi-Info 7.2.5.0 software. Linear regression and chi-square tests for trend analyzed temporal patterns (p < 0.05) were performed.
Results
Azithromycin susceptibility remained high at 94.8% (441/465; p=0.041). Fluoroquinolone resistance was catastrophic: ofloxacin susceptibility only 2.7% (12/451, p<0.001); ciprofloxacin only 2.9% (16/561; p<0.001). Both fluoroquinolones showed rapid emergence of near-universal resistance from 2015-2019 onwards. In contrast, ceftriaxone susceptibility was excellent at 98.6% (563/571), with resistance remaining minimal (1.4%, 8/571).
No significant declining trend was observed for ceftriaxone (p=0.492), though chi-square test detected annual variation (χ²=49.91, p<0.001). Isolates remained uniformly susceptible to ceftriaxone throughout 2018-2026.
Conclusion
Fluoroquinolones have become therapeutically obsolete for N. gonorrhoeae in Togo due to near-universal resistance. Azithromycin retains viability but requires monitoring. Cephalosporin susceptibility remains preserved. Third-generation cephalosporins remain the most reliable treatment option, necessitating close surveillance for emerging resistance and evaluation of combination therapies. Genomic surveillance of Neisseria gonorrhoeae antimicrobial resistance is highly needed to characterize Neisseria gonorrhoeae antimicrobial resistance patterns in Togo. Close collaboration with stakeholders involved in the surveillance of sexually transmitted infections will allow for better adaptation of treatments for sexually transmitted infections.