P045 Assessment of Neisseria gonorrhea prevalence and resistance in the Eastern Mediterranean Region

Background Neisseria gonorrhea (NG) has been identified as a high-priority public health concern because of a widespread antimicrobial resistance. The objective is to discuss the findings and implications of this emergence in the Eastern Mediterranean Region (EMR). Methods A review of paper, reports and guidelines from the region about NG was conducted. Results In 2015, the estimated prevalence of NG in the EMR was 0.7% for women and 0.6% for men compared to global estimations of 0.9% and 0.7% respectively. Prevalence in 2016 was higher by 0.2% for both men and women. Concerning antimicrobial resistance, regional countries from the EMR reporting data on gonococcal isolates with resistance to azithromycin, ciprofloxacin and extended-spectrum cephalosporins (ESCs) were 2 in 2009; 0 in 2010 and only 1 from 2011 to 2014. The reported data show full susceptibility to ESCs and azithromycin and >90% resistance to ciprofloxacin. Another report mentioned 1 reporting country in 2015 and 2016 respectively with resistances of >90% for ciprofloxacin. Cefixime, Ceftriaxone and azithromycin resistance testing were negative. Empirical articles are very scarce. In Lebanon (n=53), resistance prevalence was 38.3% to ciprofloxacin and 40.4% to azithromycin. Two papers from Morocco (n=72 and n=135) reported ciprofloxacin resistance in 86.8% and 77.9% respectively in 2013 and 2018 without ceftriaxone resistance detected. A case report from Egypt was resistant to ceftriaxone and ciprofloxacin but not to azithromycin. Discussion It is consistently clear that the EMR has the lowest number of reporting countries compared with all other regions. A call for exploration of NG epidemiology and resistance is recommended through a regional action plan to control and minimize the impact of this public health issue. The promising diagnostic technologies in NG would be beneficial for both the general and the key populations in the absence of financial support to cover current tests.