Gonococcal cervicitis among women seeking fertility care in Uganda: Prevalence, antimicrobial susceptibility patterns, and associated factors in a multicenter cross-sectional study

Gonococcal cervicitis can contribute to reproductive tract complications and infertility, yet evidence from fertility-care settings in Uganda remains limited. This study determined its prevalence, antimicrobial susceptibility patterns, and associated factors among women seeking fertility care at three tertiary hospitals in Uganda. We conducted a multicenter cross-sectional study involving 402 women seeking fertility care at three tertiary hospitals in Uganda from 10th September 2025 and 10th January 2026. Endocervical swabs were cultured for Neisseria gonorrhoeae, and isolates underwent antimicrobial susceptibility testing. Factors associated with gonococcal cervicitis were assessed using bivariable and multivariable logistic regression. Of the 402 participants, 34 had culture-confirmed gonococcal cervicitis, for an overall prevalence of 8.5% (95% CI, 6.1%-11.6%). Site-specific prevalence was 10.4% at the Jinja Regional Referral Hospital and 7.5% at both Lira and Kayunga Regional Referral Hospitals, with no significant between-site difference (p = 0.598). Among the 34 isolates, susceptibility was highest to ceftriaxone and azithromycin (94.1% each), whereas resistance was common to penicillin (64.7%), ciprofloxacin (58.8%), and tetracycline (58.8%). Independent factors associated with gonococcal cervicitis were having three or more lifetime sexual partners (adjusted odds ratio [AOR], 5.25; 95% CI, 1.65-16.72), vaginal douching (AOR, 5.59; 95% CI, 1.83-17.03), current oral contraceptive use (AOR, 8.32; 95% CI, 2.94-23.54), HIV seropositivity (AOR, 5.00; 95% CI, 1.82-13.76), and a new sexual partner in the previous 3 months (AOR, 7.92; 95% CI, 2.68-23.41). Gonococcal cervicitis was common among women seeking fertility care at these Ugandan tertiary hospitals. The observed resistance to penicillin, ciprofloxacin, and tetracycline, together with preserved susceptibility to ceftriaxone and azithromycin, supports culture-informed treatment and targeted screening in fertility clinics.