Kisumu tops counties with drug-resistant gonorrhea

Gonorrhea is a sexually transmitted infection treated using antibiotics, but it is rapidly becoming resistant to many of the drugs in the market.

Kisumu and nearby towns carry the heaviest burden of drug-resistant gonorrhoea in Kenya, according to a new genetic study of gonorrhoea bacteria collected across Kenya.

Kombewa, a small town near Kisumu, especially baffled researchers because it had the second-highest count of bacteria with drug-resistant genes in Kenya, even higher than Nairobi.

The findings suggest that where a person contracts gonorrhoea in Kenya now plays a major role in whether treatment will succeed or fail.

Gonorrhoea is a sexually transmitted infection treated using antibiotics, but it is rapidly becoming resistant to many of the drugs on the market. When an untreated infection stays in the body longer, it can cause infertility, chronic pain and a higher risk of HIV infection.

The findings of the study, conducted by researchers from Pwani University, have been peer-reviewed and published in the PLOS ONE journal.

The researchers ranked different Kenyan regions by the number of bacteria isolates with a multidrug-resistant gene. They placed Kisumu first, followed by Kombewa, then Nairobi, the Coast and finally the Rift Valley.

This ranking matters because it shows where treatment failure is most likely and where urgent action is needed. They explained that these bacteria were not different because of geography, but because of human behaviour especially misuse of antibiotics.

“Western Kenyan regions (Kisumu and Kombewa) exhibited higher AMR (antimicrobial resistant) gene counts despite genetic similarity to isolates from other regions, suggesting that local antibiotic selection pressures, rather than population isolation, are driving the accumulation of resistance determinants,” said Dennis Mukhebi, a research associate at Pwani University, who led the study alongside Henry Kiema, also from Pwani.

Their study is titled “Genetic diversity, genetic population structure and epidemiology of multidrug resistance in Neisseria gonorrhoeae from Kenya.”

The rise of drug-resistant gonorrhoea in Kombewa surprised Mukhebi’s team and suggested that resistance does not only grow in big cities. “Smaller towns with limited testing and treatment options can also become major reservoirs of resistant infections,” Mukhebi said.

The two researchers further explained why Western Kenya is especially vulnerable.

“Western Kenya may act as a hotspot for genetic exchange, facilitating the spread of antimicrobial resistance traits, thus establishing high genetic diversity and AMR genes positively correlating in these regions.”

The study explains, “Unlike many other bacteria that primarily rely on clonal expansion, Neisseria gonorrhoeae possesses a highly dynamic genome, allowing it to survive and spread even with ongoing treatment.”

This ability makes gonorrhoea especially dangerous in places where antibiotics are overused or misused. Antibiotics are often sold without a prescription in Kenya. Most people with STIs are also treated based on symptoms without lab testing and many of them stop taking medicine early.

All these practices give the bacteria more chances to adapt. The researchers studied 56 samples of gonorrhoea bacteria collected across Kenya. Bacteria from Nairobi showed mixed results. Some resistant strains were found, but overall genetic diversity was lower than in Western Kenya.

This suggests fewer active resistance networks, possibly due to better access to testing and treatment. Still, the presence of resistance in the capital is a warning sign. The Coast ranked lower than Nairobi, with fewer resistant strains detected.

However, the study cautions that limited sampling and weak surveillance could hide the true situation. Lower detection does not always mean lower risk. The Rift Valley ranked last in the study’s regional comparison. But researchers stress that this does not mean the region is safe.

As movement increases and resistant strains spread, regions with lower resistance today could face a higher risk tomorrow. Mukhebi said the results show Kenya cannot fight gonorrhoea resistance the same way everywhere.

Kisumu and Kombewa need urgent attention, while other regions need monitoring to stop resistance from spreading silently. “These regional differences in genomic heterogeneity underscore the importance of localized surveillance efforts to tailor public health interventions against N. gonorrhoeae effectively,” the study says. They also warned against treating gonorrhoea as if all strains are the same. “These findings underscore the necessity for more targeted antibiotic strategies that consider the genetic diversity and population structure of the bacterium, rather than approaching it as a homogeneous entity.”

The World Health Organisation lists drug-resistant gonorrhoea as a major antimicrobial resistance threat. Doctors in some countries are already reporting cases that do not respond to last-line antibiotics.

In 2023, Kenya Medical Research Institute researchers also isolated one strain in Nairobi that was resistant to all antibiotics. “Future control efforts should prioritise enhanced molecular surveillance in notable diversity, high resistance burden regions like Western Kenya to monitor the emergence of novel resistance types and ensure the continued efficacy of first-line therapies,” the study advises.