Susceptibility of Neisseria gonorrhoeae against a dual treatment antibiotics regimen in primary health centres in Surabaya, Indonesia

THE WORLD HEALTH ORGANIZATION (WHO) reported approximately 82.4 million new gonorrhoea cases in 2020, which did not change considerably from 87 million cases in 2018.Among the six WHO regions, the Western Pacific Region, including Australia, and the South East Asia Region, including Indonesia, ranked first and second in the number of new gonorrhoea cases in 2020, with 23.2 and 21.1 million cases, respectively. 1Local data from the Dermatology and Venereology Department of Dr. Soetomo General Academic Hospital in Surabaya, Indonesia, also showed that gonorrhoea represented 4.1% of new sexually transmitted infection (STI) cases from 2013 to 2015. 2 The management and control of gonorrhoea has been complicated by the emergence of antimicrobial resistance (AMR) in Neisseria gonorrhoeae. 3,4In the 1930s, sulphonamides were the first effective antibiotics for gonorrhoea, but resistance developed within the decade.In the 1940s, penicillin became the drug of choice for gonorrhoea.However, chromosomal-mediated resistance rapidly developed, resulting in a more than 100-fold increment in the penicillin dose required to cure gonorrhoea.In the 1970s, the emergence of penicillinase-producing N. gonorrhoeae (PPNG) rendered penicillin ineffective.Similarly, the introduction of tetracycline, spectinomycin and fluoroquinolones to treat gonorrhoea was followed by widespread resistance, leading to their discontinuation as drugs of choice. 5,6In the 1990s, third generation cephalosporins, ceftriaxone and cefixime, were introduced for gonorrhoea.][6][7] Nevertheless, the minimum inhibitory concentrations (MICs) of the constituents of this regimen gradually increased.In 2017-18, the WHO reported 0-21% gonococci isolates with reduced susceptibility (RS) to ceftriaxone, 0-22% with RS to cefixime and 0-60% with resistance to azithromycin worldwide. 3In 2019, there were 97.1% gonococci isolates resistant to tetracycline but none with RS to ceftriaxone in Jakarta, Indonesia. 8n 2021, the Australian Gonococcal Surveillance Program reported 0.9% gonococci isolates with RS, one isolate with resistance to ceftriaxone