Frequência de mutações nos genes penA, mtrR, gyrA, parC e tetM de Neisseria gonorrhoeae e resistência/susceptibilidade a antibióticos

Abstract

Sexually Transmitted Infections (STIs) are a major global public health problem and are among the top infectious diseases. Gonorrhea is a STI that affects only humans, caused by the bacterium Neisseria gonorrhoeae, known as gonococcus. The infection causes urethritis in males and cervicitis in females. If unidentified or untreated, STIs can ascend into the genital tract and result in complications such as pelvic inflammation, infertility, ectopic pregnancy, penile edema, and epididymitis. In 2016, WHO estimated 86.9 million cases of gonorrhea worldwide. In Brazil, it is estimated that there are approximately 500,000 new cases of gonorrhea per year in populations aged 15 to 49 years. Gonorrhea is currently one of the most important STI, due to the increased spread and emergence of multiresistant strains. Currently, N. gonorrhoeae is resistant to penicillins, tetracyclines, macrolides, azithromycin, sulfonamides, quinolones, and cephalosporins. The main goal was to study the relationship of resistance or decreased susceptibility to antibiotics in N. gonorrhoeae and the presence of mutations in the genes penA, mtrR, tetM, gyrA, and parC. For this, a systematic review was carried out considering the protocol proposed by PRISMA. We selected 19 studies for the penA gene, 23 for the gyrA and parC genes, 18 for the mtrR gene, and 12 for the tetM gene. Then, a meta-analysis of the studies was performed, totaling 21 meta-analyses. Meta-analysis was conducted when two or more studies were found for the same gene and the same antibiotic. Meta-analysis of isolates resistant to penicillin, cefixime and ceftriaxone shows that more than 50% of the isolates had mutations in the genes penA, and mtrR, as well as studies of isolates with reduced susceptibility to cefixime and ceftriaxone. More than 50% of azithromycin-resistant isolates had mutations in the mtrR gene. More than 50% of the resistant and intermediate-resistant isolates to ciprofloxacin had mutations in gyrA. Less than 50% of isolates with intermediate resistance to ciprofloxacin had mutations in parC. The plasmid containing the tetM gene was found in more than 50% of tetracycline-resistant isolates. The most commonly found mutations are related to resistance or a high level of resistance to antibiotics. From these studies, it is possible to improve the clinical management of gonorrhea and develop measures to contain the advance of resistance. Monitoring the infection and genetic studies are important to control the spread that can result in positive economic impacts for public health and improve the population's quality of life.