Behavioural characteristics, prevalence of Chlamydia trachomatis and antibiotic susceptibility of Neisseria gonorrhoeae in men with urethral discharge in Thyolo, Malawi.

A study was carried out in a rural district of Malawi among men presenting with urethral discharge, in order to a) describe their health seeking and sexual behaviour b) determine the prevalence of Neisseria gonorrhoeae (N.gonorrhoeae) and Chlamydia trachomatis (C.trachomatis), and c) verify the antibiotic susceptibility of N.gonorrhoeae. A total of 114 patients were entered into the study. 61% of study subjects reported having taken some form of medication before coming to the Sexually Transmitted Infections (STI) clinic. The most frequent alternative source of care was the traditional healer. 68 (60%) patients reported sex during the symptomatic period the majority (84%) not using condoms. Using ligase chain reaction on urine, N.gonorrhoeae was detected in 91 (80%) and C.trachomatis in 2 (2%) of urine specimens. 45 of 47 N.gonorrhoeae isolates produced penicillinase, 89% showing multi-anti-microbial resistance. This study emphasises the need to integrate alternative care providers and particularly traditional healers in STI control activities and to encourage their role in promoting safer sexual behaviour. In patients presenting with urethral discharge in our rural setting, C.trachomatis was not found to be a major pathogen. Antimicrobial susceptibility surveillance of N.gonorrhoeae is essential in order to prevent treatment failures and control the spread of resistant strains.