Hortense Faye-Kette

Gonococcal antimicrobial resistance: perspectives from the African region

Many countries in Africa have weak surveillance systems for data collection of sexually transmitted infections, and hardly any programmes for gonococcal antimicrobial susceptibility assessment. The widespread adoption of the syndromic approach to the diagnosis and management of sexually transmitted infections has also meant that the collection of a genital specimen for laboratory analysis is no longer routinely done when patients present with genital complaints, and clinical staff and laboratory technicians have lost the skill to collect genital specimens and processing them for culture and antimicrobial susceptibility testing. Following reports of gonococcal antimicrobial resistance to quinolones, WHO urged countries to monitor gonococcal antimicrobial resistance in a more systematic and regular manner. Although the response in Africa has been slow to take off, a number of studies have been conducted in a few countries and plans for implementation are in place in others. However, the number of isolates studied has been small in nearly all the countries except one, and the barriers to scaling up gonococcal antimicrobial resistance surveys seem overwhelming. In spite of the studies being few and of small sample sizes, enough information can be discerned to indicate that quinolones can no longer be a medicine of choice for the treatment of gonorrhoea in Africa and the threat of antimicrobial resistance developing in Neisseria gonorrhoeae to third-generation cephalosporins is real and imminent.

High prevalence of shared international type 53 among Mycobacterium tuberculosis complex strains in retreated patients from Côte d'Ivoire.

Background Genotyping methods are useful tools to provide information on tuberculosis epidemic. They can allow a better response from health authorities and the implementation of measures for tuberculosis control. This study aimed to identify the main lineages and clades of Mycobacterium tuberculosis complex strains circulating in Côte d’Ivoire. Methods/Main Findings Strains isolated from sputum samples of patients ongoing retreatment from all the country were characterized by spoligotyping and by MIRU-VNTR. Profiles obtained by spoligotyping were first compared to the SITVIT/SpolDB4 database for family assignment. Of 194 strains analysed, 146 (75.3%) belonged to the T lineage. The most predominant spoligotype was the shared international type 53 with 135 strains (69.6%). In contrast with neighbouring countries, LAM (11 strains, 5.7%) and H (9 strains 4.6%) lineages were slightly represented. Only 3 Beijing strains (1.5%) and 4 strains of Mycobacterium africanum (2%) were found. Analysis of the results obtained with MIRU-VNTR revealed also a high level of clustering. Conclusion/Significance The population of Mycobacterium tuberculosis complex strains among retreatment cases in Côte d’Ivoire exhibits a low diversity, allowing to assume recent transmission and locally based infection.

Sexually transmitted infections and cervical neoplasia.

Sir: The contribution of 2 sexually transmitted viruses, namely human papillomavirus (HPV) and HIV, in the development of cervical neoplasia has been clearly established worldwide1. The actual role of a third sexually transmitted virus, herpes simplex type 2, remains unclear2,3. Very few studies have in fact shown an association between cervical dysplasia± neoplasia and bacterial or parasitic sexually transmitted infections (STIs)4. The interrelationship between sexual behaviour, HPV, HIV and other STIs makes it dif® cult to pull out `classical’ STIs as independent risk factors for cervical neoplasia. Recently Takac et al.5 compared the frequency of Chlamydia trachomatis infection in women with and without cervical dysplasia, showing no association between chlamydial infection and dysplasia. They conclude that chlamydial infection seems not to interfere with the development or the promotion of cervical dysplasia. We would like to share our experience in this ® eld from a study with both a cross-sectional and a prospective component, conducted in African women with high HIV and STI prevalences. Between 1995 and 1996, 2037 women underwent both cervical and STI screenings in 3 outpatient gynaecology clinics in Abidjan, Coà te d’Ivoire6. In this sample, the prevalence of cervical dysplasia± neoplasia was 11.8%; it was 7.8% for low-grade squamous intraepithelial lesions (SILs), 3.1% for high-grade SILs and 0.9% for invasive carcinomas (ICs). Table 1 shows that HPV and HIV were the only infections associated with cervical dysplasia± neoplasia in univariate analysis, and HPV infection played the main role; HIV-1 was associated with SILs and HIV-2 with ICs. Bacterial and parasitic STIs were not associated with SILs or ICs, even after adjustment for potential confounders as parity, age at ® rst intercourse and number of sexual partners. Low-grade SILs were less frequent in women with candidiasis (P=0.022), but this relation disappeared when taking into account HPV and HIV results. Of the women with low-grade SILs, 94 were followed up to assess the short-term evolution of these lesions7. A median of 5 months after the initial smear, HIV-1 and HPV were the only infections signi® cantly associated with the persistence of SILs in univariate analysis, and HIV-1 infection played the main role. Persistence of SILs was slightly more frequent in women with chlamydial infection at enrolment (P=0.059), but this relation disappeared in multivariate analysis. These results reinforce the marginal contribution, if any, of classical and curable STIs in the occurrence and progression of cervical dysplasia± neoplasia5,8,9. G la Ruche MD1, H Faye-Kette MD2, H S Bankole MD2 and F Dabis MD PhD3 1National AIDS Control Program, Abidjan, 2Institut Pasteur de Cocody, Abidjan, Co à te d’Ivoire and 3Unite INSERM 330, Universite Victor Segalen, Bordeaux 2, Bordeaux, France