Burden of Gonorrhea and Trends in Antibiotic Susceptibility Pattern of Neisseria gonorrhoea in Bhutan Over Four Years (2012-15)

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Tshokey Tshokey
Ragunath Sharma
Nima Tshering
Kesang Wangchuk
Tshewang Dorji
Sangay Wangchuk
Vishal Chhetri
Damchoe Damchoe
Kinley Wangdi


Introduction: Gonorrhea is a worldwide public health problem. In Bhutan, the incidence of sexually transmitted infections increased from 12/10,000 in 2011 to 92/10,000 population in 2015. Disease burden and antibiotic resistance of Neisseria gonorrhoea have never been studied.

Aim: To study the burden of gonorrhea and trends in antibiotic susceptibility pattern of N. gonorrhoea in Bhutan.

Study Design: A descriptive, retrospective study.

Place of Study: The study was carried out in four large hospitals, the only hospitals with microbiology culture facilities in Bhutan; the Jigme Dorji Wangchuck National Referral Hospital (JDWNRH), Eastern Regional Referral Hospital (ERRH), Central Regional Referral Hospital (CRRH), and Phuentsholing General Hospital (PGH).

Methods: Laboratory data of patients investigated for gonococcal urethritis in the four hospitals; over four years (2012-15) were analyzed. Laboratory processes involved microscopy by Gram stain and culture.

Results: A total of 1,858 samples were processed; JDWNRH (60.2%, 1,119), PGH (17.7%, 329), CRRH (11.5%, 214) and ERRH (10.6%, 196). Only 1.2% (22) was females. The commonest age group was 20-30 years. There was an increasing trend in the number of cases in all hospitals. Microscopically, Gram-negative diplococci were seen in 80.7% (1,499) of cases and N. gonorrhoea was isolated in 78.3% (1,173). Only 13.6% (3/22) were culture positive in females. Resistance against nalidixic acid, ciprofloxacin, penicillin, and tetracycline were >70% but against ceftriaxone (currently recommended antibiotic), azithromycin, spectinomycin and cefpodoxime were <5% (critical resistance level for recommended therapy).

Conclusion: The burden of gonorrhea increased over years but there were only a few female patients indicating poor adherence to ‘seek and treat partners’ advocated in treatment guidelines. Compliance with treatment guidelines warrants reinforcement. With ceftriaxone resistance of 0.2%, Bhutan can continue to use it as recommended therapy with ongoing, multi-site, resistance surveillance as resistances continue to emerge and spread worldwide. Such surveillance would provide early warning or evidence to base future changes in therapeutic choices.


Antibiotic resistance, Bhutan, gonorrhea, Neisseria gonorrhea

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How to Cite
Tshokey, T., Sharma, R., Tshering, N., Wangchuk, K., Dorji, T., Wangchuk, S., Chhetri, V., Damchoe, D., & Wangdi, K. (2017). Burden of Gonorrhea and Trends in Antibiotic Susceptibility Pattern of Neisseria gonorrhoea in Bhutan Over Four Years (2012-15). International STD Research & Reviews, 5(2), 1-9. https://doi.org/10.9734/ISRR/2017/33236
Original Research Article