Risk factors associated with increasing prevalence of gonorrhea and the antimicrobial susceptibility profiles of Neisseria gonorrhoeae among adolescents: A decade-long, hospital-based study from India.

Background: Gonorrhea is a significant cause of morbidity among sexually active population. Young adults and adolescents have a high risk of contracting sexually transmitted infections (STIs) due to behavioral, biological, and cultural factors fuelling the epidemic among them. The Centers for Disease Control recommends annual STI screening for sexually active individuals under twenty-five and those at higher risk. The present study aims at determining the risk factors linked to the rising prevalence of gonorrhea among Indian adolescents and antimicrobial susceptibility profiles of Neisseria gonorrhoeae.

Materials and methods: Clinical samples from adolescents attending the STI clinics were collected over 10 years. The isolates were confirmed as N. gonorrhoeae and antimicrobial susceptibility tests were performed to various drugs using the minimum inhibitory concentration strip method.

Results: A total of 7308 genital discharge specimens were collected from STI clinic attendees, of which 417 samples were positive for gonorrhea (25 among male adolescents). Seventy six percent of positive adolescents had multiple sex partners, with only 4% using condoms. Nearly 20% practiced exchange of drugs for sex. Antimicrobial susceptibility rates were 96% sensitive for azithromycin, cefixime, and ceftriaxone. Gentamicin and spectinomycin reported 100% sensitivity rates. High resistance rates were reported to penicillin, ciprofloxacin, and tetracycline at 80%, 88%, and 68%, respectively.

Conclusion: Regular screening for STIs helps understand the trends and transmission of gonorrhea, which helps initiate appropriate control measures. The resistance to recommended treatment regimens such as azithromycin and cefixime seems to be escalating gradually, probably due to irrational use of antibiotics for non-STI cases and empirical treatment, which needs close monitoring.