Gonococcal infections(gonorrhoea) are increasingly becoming an important sexually spread infection in humans in sub-Saharan countries including Uganda. Antimicrobial resistance associated with Neisseria gonorrhoeae is rising, and spreading very fast, threatening health crisis. This study was set to investigate for antibiotic resistance and genetic characterization of circulating Neisseria gonorrhoeae strains. The study has established that largely patients were male, with average of 30 years and the adults had increased odd ratio for being sexually active. There was high genetic variation among the Neisseria gonorrhoeae strains with high sensitivity to spectinomycin and Cefixime. Findings also revealed that all coding genes; gyrA, PenA and Par C expressed resistance to antibiotics. High resistance for Penicillin, Tetracycline and Ciprofloxacin, and least resistance with Cefixime and cefoxitin. PenA was predominant in expression of resistance against all antibiotics especially Penicillin and Cefixime. Gry A and ParC coding gene exhibited the least antibiotic resistance especially for Cefixime
The findings about patients are inconsistent with findings of research by Addisu, (2020) [22], who reported higher infection in females at 30 (96.8%), and in the age groups 20–24 years. Similar observations were reported in another study by Mitiku, (2018) with higher percentage (68.3%) of females and least males (31.7%) of the patients [23]. This explained by the fact of existence of physiological and structural variations in females [24]. It’s known that males also exhibit poorer health seeking behavior than females, which makes them less likely to go to the doctor even when they are ill. On contrary, Neisseria gonorrhoeae was observed to be most prevalent in youth and adults, who are also the most sexually active age group, according to most research [25].
Further the study established that Penicillin, Ciprofloxacin and Tetracycline were ineffective against circulating Neisseria gonorrhoeae strains. This is in agreement with other two studies which [4, 26] reported 75.0% in the gyrA and parC genes known to confer high-level resistance to ciprofloxacin. Similarly, Adam L. et al (2019) observed tetracycline-resistant isolates (70.6%) which correlated with the presence of gyrA for quinolones [20]. Similarly, studies conducted in Europe and East Asia also revealed that resistance for ciprofloxacin was essentially above 50% [27]. The high resistance rates observed in this study can be attributed to overuse and misuse of antibiotics to treat common infections [28]. Unfortunately, a medication with resistance beyond the WHO recommended level of 5% should not be recommended for therapy [29]. It is likely that overuse and abuse of antibiotics to treat common diseases is to blame for the high resistance rates found in this study as was observed by Cars et al., (2008). Thus, this explains the need for antibiotic resistance monitoring in Uganda due to the escalating levels of resistance in the traditional antibiotics that are still available.
This study also reported low antibiotic resistance in cephalosporin class as first line antibiotics. This is consistent with another study which reported that first-line medicines, such as azithromycin or drugs in the cephalosporin class have low resistance [20].
The study also revealed determinants of antimicrobial resistance as encoding gene largely by penA and gyrA and least parC. This is consistent with a study which reported 75.0% of the ciprofloxacin-resistant isolates detected expressed a combination of mutations in the gyrA and parC genes that are known to promote ciprofloxacin resistance [26]. Similarly, other studies in resistance due to mutation expressed existence of correlation between the presence of gyrA (70.6%) and tetracycline resistance isolates for quinolones [20]. This is also supported by another study which a drug-associated gene mutation may be related to drug resistance [30].