Detection and Identification of Gonococci Resistance to Cephalosporin and Determination the Most Effective Empirical Treatment for Gonococcal Urethritis in Male Human in Egypt

Introduction: Gonorrhoeae and antimicrobial resistance AMR of gonococci is a major health problem today, because emerged resistance to last line empirical treatment for gonorrhoeae cephalosporins in many countries is predictable to be untreatable disease in near future. WHO GASP, WHO GLASS and WHO’s global action plan on AMR recommends to expand nationally and internationally to collect data to monitor AMR of gonococci for public health policies. Objective: Our aim is to detect resistance of gonococci to Cepha- losporins and determine the most effective empirical treatment for un-com- plicated gonococcal urethritis in males in Egypt. Methods: We depended in our methodology on selected gonococci from male urethral discharge specimens on Thyer Martien medium;collected 33 isolates during three years from 2017 to 2020;used antibiotics with MIC according to international standards and measuring IZD according to antimicrobial susceptibility testing reference ranges in international standards. Results: By statistical studies, resistance to cephalosporins was as follows: Cephradine 97%, Cefaclor 87.9%, Cefoxitin 97%, Ceftriaxone 90.9% and 42.4% to Cefepime, that shows hetero-genecity in resistance inside cephalosporin group;while resistance to Macrolides group represented by Azithromycin and Tetracyclins group represented by Doxycycline was as follows: Azithromycin 39.4%, Doxycycilne 27.3%;finally fluoroquinolones, the most effective group, resistance, was as: Levofloxacin 15.2%, Ciprofloxacin 15.2% and Ofloxacin 24.2%. Conclusion: The most effective empirical treatment for uncomplicated gonococcal urethritis in males in EGYPT is Fluoroquinolone;especially Levofloxacin ranks first susceptibility as 78.8% and 15.2% resistance followed by Ciprofloxacin susceptibility as 69.7% and 15.2% resistance, finally Ofloxacin susceptibility as 66.7% and 24.2% resistance;for Ceftriaxone not more recommended in EGYPT as empirical treatment for uncomplicated gonococcal urethritis, it is susceptibility as 6.1% and 90.9% resistance;in addition, we can use combination therapy of Fluoroquinolones with Azithromycin or Doxycycline, whose susceptibility is 30.3% for Azithromycin and 42.4% for Doxycycycline, while resistance is 39.4% for Azithromycin and 27.3% for Doxycycline. It is worth noting that only Cefepime in Cephalosporins group represents 42.4% susceptibility and 42.4% resistance;in addition to the Carbapenems group, it represents as 42.4% susceptibility for Imipenem and 45.5% resistance, then 42.2% susceptibility for Meropenem and 48.5% resistance, which can play role in combination therapy.

Gonococcal urethritis accompanied by foreskin abscess:a case report

Introduction Urethritis, a common presentation of several sexually transmitted infections, results from infectious and noninfectious conditions. Urethritis accounts for a significant burden of disease in young individuals over 2.8 million cases in the United States each year[1], and is associated with complications including acute epididymitis, orchitic, and prostatitis. Symptoms of urethritis include discharge of mucopurulent or purulent material, dysuria, or urethral frequency, pruritus. The most common infectious etiologies of urethritis are gonorrhea and chlamydia[2].

Corneal Perforation in a Patient with History of Unidentified Urethritis

Purpose: A 40-year-old male with a severe corneal melting, peripheral infiltration and nasal perforation in the right eye after a not affiliated case of urethritis is reported. Methods: Retrospective case report. Results: A sample of conjunctival discharge was sent to culture, in where Gram-diplococci grew and therefore a systemic antibiotic treatment was initiated. Given the severity of the clinic, a penetrating keratoplasty is conducted two days after admission and the corneal button was sent to microbiology, which polymerase chain reaction was positive for Neisseria gonorrhoeae. Conclusion: Despite it being a rare process in an adult, keratitis caused by Neisseria gonorrhoeae should be suspected in all sexually active patients with conjunctivitis and with a clinic genitourinary medical history. The systemic therapy showed a superior effectiveness in combination with topical therapy than the last one on its own.

Radiologic diagnosis of Fitz-Hugh-Curtis syndrome

Fitz-Hugh-Curtis syndrome （FHCS） was reported by Curtis after he found a fibrous adhesion between the surface of the liver and peritoneum in patients with gonococcal pelvic inflammation during laparoscopy in 1930, and the first report by Fitz-Hugh as acute gonococcal peritonitis in the right upper quadrant abdomen was published in 1934, The so-called FHCS is believed to originate from an inflammation in the pelvis which may ascend toward the diaphragmatic surface of the liver along the right paracolic gutters to cause the inflammation of the liver capsule with right upper abdominal pain. Previously, FHCS was only seen in females at the age of 20 and 30 years and was often misdiagnosed as acute cholecystitis, cholelithiasis, gastrointestinal diseases, pleuritis, etc., because of involvement of the liver capsule and peritoneum with right upper abdominal pain as the major clinical symptom, which was related to the respiratory movement. We retrospectively reviewed 21 patients with FHCS to evaluate the clinical manifestations and CT and MRI findings of this disease.