Ciprofloxacin-resistant Neisseria gonorrhoeae in men treated for gonococcal urethritis at the City Institute for Skin and Venereal Diseases in Belgrade

Background/Aim: Gonorrhea is an acute sexually transmitted infection caused by Neisseria gonorrhoeae (NG), which affects the columnar and transitional epithelium of the urethra, cervix, rectum, and pharynx. Over the past decade, an increase in NG resistance to antibiotics from the macrolide, tetracycline, and quinolone groups has been reported in European Union countries, while resistance to ceftriaxone has remained extremely rare. The aim of this study was to determine the frequency of ciprofloxacin-resistant NG strains among patients treated for gonococcal urethritis, as well as the characteristics of patients with gonorrhea in relation to antimicrobial resistance.Methods: The study included 55 men who presented to a dermatologist due to purulent urethral discharge. Data on patient age, sexual orientation, previous history of gonorrhea, and HIV status were obtained from the medical records of patients diagnosed with gonorrhea. Clinical samples for NG culture were collected using appropriate swabs, inoculated onto selective and non-selective culture media, and incubated in a humid atmosphere containing 5% CO₂ at 37°C for 18-24 hours. Oxidase-positive colonies were analyzed using the MALDI-TOF MS (matrix-assisted laser desorption ionization time-of-flight) system, which confirmed the identification of NG. Antimicrobial susceptibility testing was performed using the E-test method on appropriate culture media. Interpretation of antimicrobial susceptibility results was performed in accordance with the standards of the European Committee on Antimicrobial Susceptibility Testing (EUCAST), according to which an NG isolate is considered sensitive to ciprofloxacin if the minimum inhibitory concentration (MIC) is less than or equal to 0.03 mg/L, and resistant if the MIC is greater than 0.06 mg/L. Statistical data analysis was performed using the χ² test. Results: Ciprofloxacin resistance was detected in 67.3% of patients. Men with gonorrhea who had ciprofloxacin-resistant NG isolates were significantly more likely to be men who have sex with men (MSM) (p = 0.004) and to have a previous history of gonorrhea in their personal medical history (p < 0.05). Conclusion: The high prevalence of ciprofloxacin-resistant NG isolates, particularly among the MSM population, indicates the need to avoid the empirical use of this drug for the treatment of gonorrhea in this population, as well as the need for antimicrobial susceptibility testing of gonococcal isolates.