Prevalence and Antimicrobial Resistance Profiles of Neisseria gonorrhoeae and Associated Factors among Women with Suspected STIs in Bahir Dar City, Northwest Ethiopia

Abstract Background Neisseria gonorrhoeae is a causative agent of gonorrhoeae, remaining a major public health concern globally, due to the growing threat of antimicrobial resistance (AMR), particularly in Africa, including Ethiopia. However, regarding Neisseria gonorrhoeae prevalence, AMR pattern and associated risk factor few data are available due to lack of continuous, up to date surveillance and research. Methods To assess the prevalence and antimicrobial resistance of N. gonorrhoeae , as well as associated factors a cross-sectional study involving 261 women with suspected STIs was conducted in Bahir Dar City, Ethiopia between February and May 2025. Convenience sampling technique was employed to enroll study participants. Data was collected through structured interviews, and standard microbiological techniques were used to collect, transfer, and cultivate endocervical swabs. Cervical swabs were incubated on Modified Thayer Martin agar at 36 ± 1°C in 5% CO₂ for 24 hours. Gram staining, colony morphology, and biochemical assays were used to identify the bacteria. The disc diffusion method was used to evaluate antibiotic susceptibility. Logistic regression was used to assess associations between independent variables and gonorrhoeae infection. Results The prevalence of Neisseria gonorrhoeae was 8% (21/161) (95% CI: 4.7%-11.3%). Risk factors such as infertility history (AOR = 4.0, 95% CI: 1.147–14.09, p: 0.03), and having 5–6 lifetime sexual partners (AOR: 5.6, 95% CI: 1.39–22.5, p: 0.01) were significantly associated with gonorrhoeae infection. All N. gonorrhoeae isolates were fully susceptible to ceftriaxone and azithromycin but showed high resistance to ciprofloxacin (52.4%), penicillin (95.2%), and tetracycline (95.2%). Conclusion The study revealed a high prevalence of N. gonorrhoeae and Factors such as infertility history, family planning use, elevated vaginal pH and abnormal Donders’ scores, were significantly associated with infection. Additionally, high resistance to ciprofloxacin, penicillin, and tetracycline was documented. To reduce antibiotic resistance and protect reproductive health from gonorrhoeae, it is essential to improve STI screening, prevention, and antibiotic stewardship. Because of the study's cross-sectional design and sample size, the evidence must be assessed carefully.