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Epidemiology & Monitoring

Category: Gonorrhoea - AMR

(P63) The Enhanced Gonococcal Antimicrobial Surveillance Program (EGASP) reveals increasing cases of meningococcal urethritis among males in sentinel clinics in Metro Manila, Philippines

Tuesday, July 25, 2023
16:00 – 18:00 CST
Background. Neisseria meningitidis causing urethritis has been reported worldwide; however, this has not been reported in the Philippines. Here we describe the demographic profile, sexual behaviors, and clinical characteristics of patients with meningococcal urethritis from the Philippine Enhanced Gonococcal Antimicrobial Surveillance Program (EGASP) and determine the antimicrobial resistance profile of this pathogen.



Methods. A total of 1,069 urethral swabs from male patients presenting with urethral discharge were collected from July 2018 to August 2022 among three STD clinics across Metro Manila, Philippines. These clinics served as sentinel sites for the Philippine EGASP Research Institute for Tropical Medicine team. Review of archived case reports and laboratory forms was undertaken for 17 patients with laboratory confirmed cases of meningococcal urethritis. Antimicrobial susceptibility testing for N. meningitidis was performed according to Clinical and Laboratory Standard Institute guidelines.



Results. The first case of laboratory confirmed meningococcal urethritis for Philippine EGASP was seen in 2020 from a 17-year-old male with history of unprotected sex with men. Prior to this report, there had been no case of N. meningitidis urethritis recorded in EGASP from 2018 to 2019. Three (3) more cases of laboratory confirmed meningococcal urethritis were reported for 2021 and 13 cases for 2022. All 17 cases were males having sex with males with 4 living with HIV and 1 having syphilis. Syndromic treatment of all cases upon consultation in the clinics with a 3rd generation cephalosporin together with azithromycin was undertaken. Data on the outcome was unavailable. All isolates were susceptible to cefotaxime, ceftriaxone, meropenem, azithromycin, chloramphenicol, and rifampin; 29.41% were resistant to ciprofloxacin and 100% were resistant to cotrimoxazole.



Conclusions. The study presents insights on urethritis caused by N. meningitidis in the Philippines providing preliminary understanding of this emerging infection in the country. Genomic studies of the isolates will allow for more granular characterization as to sequence types and serotypes and can likewise provide understanding of the emergence and spread of these isolates to inform prevention and control measures.