The Prevalence of Neisseria gonorrhoeae in KwaZulu-Natal: A Retrospective Analysis of Laboratory-Confirmed Cases

Khethiwe Bhengu; Nonhlanhla Phumzile Ngobese

doi:10.51168/sjhrafrica.v6i12.2238

Authors

Khethiwe Bhengu Mangosuthu University of Technology https://orcid.org/
Nonhlanhla Phumzile Ngobese Department of Biomedical Sciences, Faculty of Applied and Health Science, Mangosuthu University of Technology, Durban, South Africa

DOI:

https://doi.org/10.51168/sjhrafrica.v6i12.2238

Keywords:

Neisseria gonorrhoeae, gonorrhoea, sexually transmitted infections,, surveillance, neonatal infection, NHLS, antimicrobial resistance, KwaZulu-Natal, South Africa

Abstract

Background: Neisseria gonorrhoeae remains a public health challenge in South Africa, which is exacerbated by antimicrobial resistance and under-reporting, particularly among women and neonates. Surveillance targets adult populations, while neonatal infections are rarely documented. The reliance on syndromic treatment without laboratory confirmation contributes to undetected infections, propagation of resistant strains, adverse long-term health outcomes, and an economic burden on the public health system. These factors highlight the need for improved surveillance and targeted interventions. Laboratory data from the National Health Laboratory Service offers a complementary source for surveillance.

Aim: To describe the demographic, temporal, and facility-level distribution of laboratory-confirmed N. gonorrhoeae cases in KwaZulu-Natal during 2024.

Methods: A retrospective analysis of all laboratory-confirmed cases of N. gonorrhoeae diagnosed at public healthcare facilities in KZN between January 2024 and December 2024. Data included patient age, sex, specimen source, healthcare facility, diagnosis date, and temporal trends were summarised using descriptive statistics. The GeneXpert® CT/NG assay was used for laboratory confirmation.

Results: Twenty-two laboratory-confirmed cases were identified. The median patient age was 26 years. Interquartile Range: 4 days–47 years, with neonates (<10 days old) comprising 27% (n = 6) of cases. Males accounted for 55% (n = 12). McCord’s Hospital reported the highest proportion (45%) (n = 10) of cases, followed by Addington Hospital (18%) (n = 4). A temporal cluster occurred in July 2024, affecting 27% (n = 6) of cases. Most specimens were pus samples, 81% (n = 18).

Conclusions: The high proportion of neonatal cases indicates failures in antenatal screening and prevention of mother-to-child transmission, leading to ophthalmia neonatorum. Facility clustering suggests unequal diagnostic capacity across KZN. Reliance on syndromic management may mask the true burden and economic impact of the disease. Strategic integration of laboratory-confirmed data can complement syndromic approaches, improve surveillance strategies and inform targeted public health interventions

Author Biography

Nonhlanhla Phumzile Ngobese, Department of Biomedical Sciences, Faculty of Applied and Health Science, Mangosuthu University of Technology, Durban, South Africa

Nonhlanhla Phumzile Ngobese is a registered Bachelor of Health Science student in Medical Laboratory Science at Mangosuthu University of Technology, majoring in Clinical Pathology. She is a committed and driven scholar whose academic excellence was recognised when she received the award for Best Presentation during the Laboratory Practice I student symposium for their work titled “Breast Cancer.”

References

Gaydos, C.A. et al. (2013) “Performance of the cepheid CT/NG Xpert rapid PCR test for detection of Chlamydia trachomatis and Neisseria gonorrhoeae,” Journal of Clinical Microbiology, 51(6), pp. 1666–1672. Available at: https://doi.org/10.1128/JCM.03461-12;W.

Harryparsad, R. et al. (2023) “Prevalence and incidence of sexually transmitted infections among South African women initiating injectable and long-acting contraceptives,” PloS one, 18(11). Available at: https://doi.org/10.1371/JOURNAL.PONE.0294285.

Inside the Numbers: SA Population Trends for 2025 | Statistics South Africa (no date). Available at: https://www.statssa.gov.za/?p=18613 (Accessed: November 6, 2025).

Jacobs, J. et al. (2019) “Diagnostic Bacteriology in District Hospitals in Sub-Saharan Africa: At the Forefront of the Containment of Antimicrobial Resistance,” Frontiers in Medicine, 6, p. 459158. Available at: https://doi.org/10.3389/FMED.2019.00205/FULL.

Kufa, T. et al. (2025) “Microbiological sentinel surveillance of sexually transmitted infection syndromes in South Africa, 2021-2024 Public Health Bulletin South Africa 2.”

Kularatne, Ranmini S et al. (2018) “Adult gonorrhoea, chlamydia and syphilis prevalence, incidence, treatment and syndromic case reporting in South Africa: Estimates using the Spectrum-STI model, 1990-2017,” PLoS ONE, 13(10), p. 205863. Available at: https://doi.org/10.1371/journal.pone.0205863.

Lekodeba, N. et al. (2025) “Cost, cost-effectiveness and budget impact analysis of near point-of-care GeneXpert testing for STIs in South Africa: leveraging current capacity to address high prevalence of Chlamydia trachomatis, Neisseria gonorrhoeae and Trichomonas vaginalis,” medRxiv, p. 2024.12.13.24319006. Available at: https://doi.org/10.1101/2024.12.13.24319006.

Lewis, D.A. et al. (2013) “Phenotypic and genetic characterisation of the first two cases of extended-spectrum-cephalosporin-resistant Neisseria gonorrhoeae infection in South Africa and association with cefixime treatment failure,” Journal of Antimicrobial Chemotherapy, 68(6), pp. 1267–1270. Available at: https://doi.org/10.1093/jac/dkt034.

Medina-Marino, A. et al. (2022) “Sexually transmitted infection screening to prevent adverse birth and newborn outcomes: study protocol for a randomized-controlled hybrid-effectiveness trial,” Trials, 23(1). Available at: https://doi.org/10.1186/S13063-022-06400-Y.

Mfuh, K.O., Abanda, N.N. and Titanji, B.K. (2023) “Strengthening diagnostic capacity in Africa as a key pillar of public health and pandemic preparedness,” PLOS Global Public Health, 3(6), p. e0001998. Available at: https://doi.org/10.1371/JOURNAL.PGPH.0001998.

Mitchev, N. et al. (2021) “Antimicrobial Resistance Mechanisms, Multilocus Sequence Typing, and NG-STAR Sequence Types of Diverse Neisseria gonorrhoeae Isolates in KwaZulu-Natal, South Africa,” Antimicrobial Agents and Chemotherapy, 65(10), pp. e00759-21. Available at: https://doi.org/10.1128/AAC.00759-21.

Nyemba, D.C. et al. (2022) “Impact of aetiological screening of sexually transmitted infections during pregnancy-on-pregnancy outcomes in South Africa,” BMC Pregnancy and Childbirth 2022 22:1, 22(1), pp. 1–11. Available at: https://doi.org/10.1186/S12884-022-04520-6.

Peters, R. (2023) “Towards STI control in South Africa.”

South African National HIV Prevalence, Incidence and Behaviour Survey, 2012 (no date). Available at: https://repository.hsrc.ac.za/handle/20.500.11910/2490 (Accessed: November 6, 2025).

WHO and UNICEF (2018) “Reaching Every Newborn National 2020 Milestones,” (March 2018), p. 110. Available at: https://www.healthynewbornnetwork.org/hnn-content/uploads/Final-Country-Progress-Report-v9-low-res.pdf (Accessed: November 6, 2025).

Wi, T.E.C. et al. (2019) “Diagnosing sexually transmitted infections in resource-constrained settings: challenges and ways forward,” Journal of the International AIDS Society, 22 (Suppl 6). Available at: https://doi.org/10.1002/JIA2.25343.

World Health Organisation (2024) Gonorrhoea (Neisseria gonorrhoeae infection). Available at: https://www.who.int/news-room/fact-sheets/detail/gonorrhoea-(neisseria-gonorrhoeae-infection) (Accessed: June 1, 2025).