Following three recent cases, concern is growing that Gonorrhoea, a sexually transmitted infection, is showing resistance to antibiotics in South Africa, especially among men who have sex with men (MSM).

Experts worry that resistance is especially developing to the antibiotic cefixime, recommended by the South African Department of Health for treating gonococcal urethritis (gonorrhoea affecting the urethra). 

The gonorrhoea bacteria, also referred to as “the drop” or “the clap,” is transmitted through unprotected oral, anal and vaginal sex and sharing of sex toys, and is known to increase the risk of HIV transmission.

There have been two recent cases of multi-drug resistant gonorrhoea among MSM in Johannesburg identified by Dr David Lewis of the National Institute of Communicable Diseases. A third case of drug resistant gonorrhoea has subsequently been identified in Cape Town.

Gonorrhoea resistance is more common among men who have sex with men (MSM) than heterosexual men, although it’s not entirely clear why this is the case.

Currently, diagnosis and treatment at government clinics is based on a syndromic approach, meaning treatment is based on observable clinical symptoms rather than laboratory tests.

As a result, clinic staff have no way of knowing whether the particular strain of gonorrhoea is resistant to certain antibiotics, making treatment failure in these cases likely.

Anova Health Institute, through its Health4Men programme, has now initiated enhanced screening services for MSM at its Ivan Toms Centre for Men in Cape Town.

“This is an important concern because the current South African STI syndromic treatment guidelines will not identify drug resistant gonorrhoea and resistant strains could be spreading among vulnerable key populations without being detected,” said Dr Kevin Rebe from Health4Men.

He explained that the screening was initiated in Cape Town simply because the capacity existed there to start without delay. Health4Men intends to do similar screening in Johannesburg, once capacity is available.

“It is probably not feasible to roll this out beyond two sites, but two sites, acting as ‘sentinel surveillance sites’ and working together with the surveillance program at the National Institute of Communicable Diseases in Johannesburg, will allow us to determine if there is a problem and what the scale is,” said Rebe.

“Only three cases have been found so far in total, so the numbers are too small to estimate any trends,” he noted.

Rebe urged gay, bi men and MSM to use condoms as these can help to prevent gonorrhoea infections, although acknowledging that their use in oral sex is not common.

“I would recommend that anyone who suspects they may have an STI (penile or anal discharge or non-healing sore throat without common cold symptoms) should see their health provider. If they are considered likely to have been exposed to an STI, they will receive treatment with dual antibiotics.

“If the symptoms don’t heal, drug resistant gonorrhoea should be suspected, a swab taken for the lab and additional ‘stronger’ antibiotics given. Known sexual partners should also be treated,” Rebe said.

He added that Health4Men will advise of any developments to the MSM community.

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