A systematic review of antimicrobial resistance in Neisseria gonorrhoeae and Mycoplasma genitalium in sub-Saharan Africa

Introduction Limited antimicrobial resistance (AMR) surveillance coupled with syndromic management of sexually transmitted infections (STIs) in sub-Saharan Africa (SSA) could be contributing to an increase in AMR in the region. This systematic review aims to synthesise data on the prevalence of AMR in common STIs in SSA and identify some research gaps that exist. Methods We searched three electronic databases for studies published between 1 January 2000 and 26 May 2020. We screened the titles and abstracts for studies that potentially contained data on AMR in SSA. Then we reviewed the full text of these studies to identify articles that reported data on the prevalence of AMR in Neisseria gonorrhoeae (NG), Chlamydia trachomatis (CT), Trichomonas vaginalis (TV) and Mycoplasma genitalium (MG) in SSA. We summarised the data using a narrative synthesis. Results The 40 included studies reported on AMR data from 7961 NG isolates from 15 countries in SSA and 350 MG specimens from South Africa. All four SSA regions reported very high rates of ciprofloxacin, tetracycline and penicillin resistance in NG. Resistance to cefixime or ceftriaxone was observed in all regions except West Africa. Azithromycin resistance, recommended as part of dual therapy with the ESC for gonorrhoea, was reported in all the regions. Both macrolide and fluoroquinolone-associated resistance were reported in MG in South Africa. Studies investigating AMR in CT and TV were not identified. Conclusion There is a need to strengthen AMR surveillance in SSA for prompt investigation and notification of drug resistance in STIs.