Etiological profile of male urethritis and genital ulcer disease and antimicrobial susceptibility of Neisseria gonorrhoeae in Southeastern Brazil

Sexually Transmitted Infections (STIs) are major causes of male urethritis and genital ulcer disease, with increasing concern about antimicrobial resistance, particularly in Neisseria gonorrhoeae . This study aimed to describe the etiological profile of male urethritis and genital ulcer disease and to evaluate the antimicrobial resistance profile of Neisseria gonorrhoeae isolates in a medium-sized Brazilian city. To address the study objectives, a descriptive study was conducted among men aged 18-years or older presenting with urethral discharge and/or genital ulcers at STI reference services in Ribeirão Preto, São Paulo State, Brazil. Urethral and ulcer swabs were analyzed using molecular assays to identify etiological agents. Antimicrobial susceptibility testing of N. gonorrhoeae isolates was performed by determining minimum inhibitory concentrations according to international standards. A total of 144 samples were obtained from 134 men (mean age: 29-years), including 126 urethral samples and 18 genital ulcer disease samples. Neisseria gonorrhoeae was detected in 108 urethral samples (85.7 %), while Chlamydia trachomatis was identified in 45 (35.7 %), frequently in coinfections. Among genital ulcer disease cases, herpes simplex virus type 2 was detected in 7 cases (38.9 %), Treponema pallidum in 6 (33.3 %), and no pathogen was identified in 4 cases (22.2 %). Antimicrobial susceptibility testing was successfully performed in 95 Neisseria gonorrhoeae isolates, showing resistance rates of 71.7 % to ciprofloxacin, 43.5 % to tetracycline, and 26.1 % to penicillin, with complete susceptibility to ceftriaxone and cefixime. Coinfection with Chlamydia trachomatis and Neisseria gonorrhoeae occurred in 35 samples (28 %). Neisseria gonorrhoeae and Chlamydia trachomatis are the leading causes of male urethritis, whereas herpes simplex virus type 2 and Treponema pallidum predominate among cases of genital ulcer disease. The high prevalence of ciprofloxacin resistance reinforces the need for continuous antimicrobial resistance surveillance and supports current guidelines recommending ceftriaxone as first-line therapy.