{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T18:09:47Z","timestamp":1788890987397,"version":"build-2803163510"},"reference-count":44,"publisher":"Public Library of Science (PLoS)","issue":"9","license":[{"start":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T00:00:00Z","timestamp":1788825600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosglobalpublichealth.org"],"crossmark-restriction":false},"short-container-title":["PLOS Glob Public Health"],"abstract":"<jats:p>\n                    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\n                    <jats:italic>Neisseria gonorrhoeae<\/jats:italic>\n                    , 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%\u201311.6%). 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\u2009=\u20090.598). 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\u201316.72), vaginal douching (AOR, 5.59; 95% CI, 1.83\u201317.03), current oral contraceptive use (AOR, 8.32; 95% CI, 2.94\u201323.54), HIV seropositivity (AOR, 5.00; 95% CI, 1.82\u201313.76), and a new sexual partner in the previous 3 months (AOR, 7.92; 95% CI, 2.68\u201323.41). 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.\n                  <\/jats:p>","DOI":"10.1371\/journal.pgph.0006796","type":"journal-article","created":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T17:45:00Z","timestamp":1788889500000},"page":"e0006796","update-policy":"https:\/\/doi.org\/10.1371\/journal.pgph.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Gonococcal cervicitis among women seeking fertility care in Uganda: Prevalence, antimicrobial susceptibility patterns, and associated factors in a multicenter cross-sectional study"],"prefix":"10.1371","volume":"6","author":[{"given":"Mohamed Mire","family":"Amina","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Musa","family":"Kasujja","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marie Pascaline Sabine","family":"Ishimwe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amina Aden","family":"Ahmed","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hudaifa Iman","family":"Yusuf","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Theodore","family":"Nteziyaremye","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bahja Ahmed","family":"Mumin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali Abdow","family":"Hafsa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed Farah","family":"Ismail","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adam Abdrahim Sulaiman","family":"Ebaid","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean de Dieu","family":"Rukamba","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ronard","family":"Musinguzi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sawda Abdikarim Sheikh","family":"Isse","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Theoneste","family":"Hakizimana","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,9,8]]},"reference":[{"issue":"4","key":"pgph.0006796.ref001","doi-asserted-by":"crossref","first-page":"411","DOI":"10.1093\/humupd\/dmv016","article-title":"Infertility around the globe: new thinking on gender, reproductive technologies and global movements in the 21st century","volume":"21","author":"MC Inhorn","year":"2015","journal-title":"Hum Reprod Update"},{"issue":"21","key":"pgph.0006796.ref002","doi-asserted-by":"crossref","first-page":"2039","DOI":"10.1056\/NEJMra1411426","article-title":"Pelvic inflammatory disease. Campion EW, editor","volume":"372","author":"RC Brunham","year":"2015","journal-title":"N Engl J Med"},{"issue":"3","key":"pgph.0006796.ref003","doi-asserted-by":"crossref","first-page":"80","DOI":"10.15585\/mmwr.mm6603a3","article-title":"Prevalence of pelvic inflammatory disease in sexually experienced women of reproductive age \u2014 United States, 2013\u20132014","volume":"66","author":"K Kreisel","year":"2017","journal-title":"MMWR Morb Mortal Wkly Rep"},{"issue":"7","key":"pgph.0006796.ref004","doi-asserted-by":"crossref","first-page":"1170","DOI":"10.3390\/jpm13071170","article-title":"Chlamydial and gonococcal genital infections: a narrative review","volume":"13","author":"R Rodrigues","year":"2023","journal-title":"J Pers Med"},{"issue":"4","key":"pgph.0006796.ref005","doi-asserted-by":"crossref","first-page":"2170","DOI":"10.3390\/ijms22042170","article-title":"The impact of selected bacterial sexually transmitted diseases on pregnancy and female fertility","volume":"22","author":"K Smolarczyk","year":"2021","journal-title":"IJMS"},{"key":"pgph.0006796.ref006","article-title":"Prevalence, regional distribution, and determinants of infertility in Uganda between 2006 and 2016: analysis of three Demographic and Health Surveys","volume":"8","author":"D Zaake","year":"2024","journal-title":"J Glob Health Rep"},{"issue":"1","key":"pgph.0006796.ref007","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1186\/s40738-020-00090-3","article-title":"Primary and secondary infertility in Africa: systematic review with meta-analysis","volume":"6","author":"MS Abebe","year":"2020","journal-title":"Fertil Res Pract"},{"key":"pgph.0006796.ref008","unstructured":"MOH Uganda. The national policy guidelines and service standards for sexual and reproductive health and rights [Internet]; 2017. Available from: https:\/\/platform.who.int\/docs\/default-source\/mca-documents\/policy-documents\/guideline\/uga-cc-31-01-guideline-2017-eng-srhr-policy-guidelines-and-service-standards.pdf?"},{"key":"pgph.0006796.ref009","article-title":"Exploring the psychological implications of infertility among IVF parents in Uganda using the transactional theory of stress and coping","author":"S Ouma","year":"2026","journal-title":"BMC Psychol"},{"issue":"1","key":"pgph.0006796.ref010","doi-asserted-by":"crossref","first-page":"750","DOI":"10.1186\/s12913-026-14534-x","article-title":"A cross-sectional survey of service delivery for infertility in Uganda: gaps, opportunities and a way forward","volume":"26","author":"D Zaake","year":"2026","journal-title":"BMC Health Serv Res"},{"issue":"2","key":"pgph.0006796.ref011","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1136\/sextrans-2020-054515","article-title":"Global epidemiology of Neisseria gonorrhoeae in infertile populations: systematic review, meta-analysis and metaregression","volume":"97","author":"H Chemaitelly","year":"2021","journal-title":"Sex Transm Infect"},{"issue":"12","key":"pgph.0006796.ref012","doi-asserted-by":"crossref","first-page":"2653","DOI":"10.4314\/tjpr.v15i12.17","article-title":"Antimicrobial susceptibility pattern of Neisseria gonorrhoeae isolated from fertile and infertile women","volume":"15","author":"S Azizmohammadi","year":"2017","journal-title":"Trop J Pharm Res"},{"issue":"8","key":"pgph.0006796.ref013","doi-asserted-by":"crossref","first-page":"773","DOI":"10.1177\/0956462420922462","article-title":"Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis among women with genitourinary infection and pregnancy-related complications in Tehran: a cross-sectional study","volume":"31","author":"M Rajabpour","year":"2020","journal-title":"Int J STD AIDS"},{"issue":"1","key":"pgph.0006796.ref014","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1186\/s12978-022-01502-x","article-title":"Prevalence of reproductive tract infections among women preparing to conceive in Chongqing, China: trends and risk factors","volume":"19","author":"J Liu","year":"2022","journal-title":"Reprod Health"},{"issue":"5","key":"pgph.0006796.ref015","article-title":"Population-based study of chlamydial and gonococcal infections among women in Shenzhen, China: implications for programme planning","volume":"13","author":"Z-Z Luo","year":"2018","journal-title":"PLoS One"},{"issue":"2","key":"pgph.0006796.ref016","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0263531","article-title":"Neisseria gonorrhoeae infection in female sex workers in an STI clinic in Nairobi, Kenya","volume":"17","author":"A Abdullahi","year":"2022","journal-title":"PLoS One"},{"issue":"4","key":"pgph.0006796.ref017","first-page":"186","article-title":"The prevalence and antibiotics susceptibility pattern of Neisseria gonorrhoeae in patients attending OPD clinics at St. Mary\u2019s Hospital Lacor Uganda","volume":"53","author":"P Amito Florence","year":"2012","journal-title":"J Prev Med Hyg"},{"key":"pgph.0006796.ref018","doi-asserted-by":"crossref","first-page":"4065","DOI":"10.2147\/IDR.S416344","article-title":"Prevalence, antibiotic resistance and associated factors of Neisseria gonorrhoeae among patients attending non-profitable private clinics in Mekelle, Tigrai, Ethiopia","volume":"16","author":"AG Kahsay","year":"2023","journal-title":"Infect Drug Resist"},{"issue":"2","key":"pgph.0006796.ref019","doi-asserted-by":"crossref","first-page":"52","DOI":"10.18203\/issn.2454-2156.IntJSciRep20190252","article-title":"Prevalence and antimicrobial susceptibility patterns of Neisseria gonorrhea among the symptomatic patients attending outpatient department in Lyatonde District Hospital southwestern Uganda","volume":"5","author":"N Peace","year":"2019","journal-title":"Int J Sci Rep"},{"key":"pgph.0006796.ref020","doi-asserted-by":"crossref","first-page":"7672024","DOI":"10.1155\/2020\/7672024","article-title":"Prevalence and antimicrobial susceptibility patterns of Neisseria gonorrhoeae among suspected patients attending private clinics in Jimma, Ethiopia","volume":"2020","author":"A Sahile","year":"2020","journal-title":"Int J Microbiol"},{"key":"pgph.0006796.ref021","doi-asserted-by":"crossref","first-page":"790531","DOI":"10.3389\/fmicb.2021.790531","article-title":"Cervicovaginal microbiota predicts Neisseria gonorrhoeae clinical presentation","volume":"12","author":"A Lovett","year":"2022","journal-title":"Front Microbiol"},{"issue":"11","key":"pgph.0006796.ref022","doi-asserted-by":"crossref","DOI":"10.1172\/JCI184322","article-title":"Social, microbial, and immune factors linking bacterial vaginosis and infectious diseases","volume":"135","author":"NM Gilbert","year":"2025","journal-title":"J Clin Invest"},{"issue":"1","key":"pgph.0006796.ref023","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1186\/s40168-021-01096-9","article-title":"Modeling the temporal dynamics of cervicovaginal microbiota identifies targets that may promote reproductive health","volume":"9","author":"A Munoz","year":"2021","journal-title":"Microbiome"},{"issue":"8","key":"pgph.0006796.ref024","doi-asserted-by":"crossref","first-page":"2074","DOI":"10.1093\/jac\/dkac159","article-title":"A systematic review of antimicrobial resistance in Neisseria gonorrhoeae and Mycoplasma genitalium in sub-Saharan Africa","volume":"77","author":"C Iwuji","year":"2022","journal-title":"J Antimicrob Chemother"},{"issue":"4","key":"pgph.0006796.ref025","doi-asserted-by":"crossref","first-page":"506","DOI":"10.1111\/lam.13520","article-title":"Association of Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma genitalium and Ureaplasma species infection and organism load with cervicitis in north Indian population","volume":"73","author":"A Roy","year":"2021","journal-title":"Lett Appl Microbiol"},{"key":"pgph.0006796.ref026","unstructured":"MOH Uganda. Consolidated guidelines for the prevention and treatment of HIV and AIDS in Uganda [Internet]; 2020. Available from: https:\/\/elearning.idi.co.ug\/wp-content\/uploads\/2022\/05\/Consolidated-Guidelines-for-the-Prevention-and-Treatment-of-HIV-and-AIDS-in-Uganda-2020.pdf?"},{"key":"pgph.0006796.ref027","doi-asserted-by":"crossref","DOI":"10.1093\/cid\/ciac043","article-title":"Management of Neisseria gonorrhoeae in the United States: summary of evidence from the development of the 2020 gonorrhea treatment recommendations and the 2021 centers for disease control and prevention sexually transmitted infection treatment guidelines","volume":"74","author":"LA Barbee","year":"2022","journal-title":"Clin Infect Dis"},{"issue":"10","key":"pgph.0006796.ref028","doi-asserted-by":"crossref","first-page":"1153","DOI":"10.1007\/s40265-021-01530-0","article-title":"Epidemiology, treatments, and vaccine development for antimicrobial-resistant Neisseria gonorrhoeae: current strategies and future directions","volume":"81","author":"EY Lin","year":"2021","journal-title":"Drugs"},{"issue":"7","key":"pgph.0006796.ref029","doi-asserted-by":"crossref","first-page":"1065","DOI":"10.1007\/s10096-017-2931-x","article-title":"Drug-resistant Neisseria gonorrhoeae: latest developments","volume":"36","author":"B Suay-Garc\u00eda","year":"2017","journal-title":"Eur J Clin Microbiol Infect Dis"},{"issue":"5","key":"pgph.0006796.ref030","doi-asserted-by":"crossref","first-page":"412","DOI":"10.1071\/SH19023","article-title":"World Health Organization Global Gonococcal Antimicrobial Surveillance Program (WHO GASP): review of new data and evidence to inform international collaborative actions and research efforts","volume":"16","author":"M Unemo","year":"2019","journal-title":"Sex Health"},{"issue":"14","key":"pgph.0006796.ref031","doi-asserted-by":"crossref","first-page":"62","DOI":"10.3201\/eid3014.240296","article-title":"Common patterns and unique threats in antimicrobial resistance as demonstrated by global gonococcal surveillance","volume":"30","author":"A Le Van","year":"2024","journal-title":"Emerg Infect Dis"},{"issue":"3","key":"pgph.0006796.ref032","doi-asserted-by":"crossref","first-page":"256","DOI":"10.1177\/0956462418799017","article-title":"Complete ciprofloxacin resistance in gonococcal isolates in an urban Ugandan clinic: findings from a cross-sectional study","volume":"30","author":"E Mabonga","year":"2019","journal-title":"Int J STD AIDS"},{"key":"pgph.0006796.ref033","unstructured":"WHO. Sexually transmitted infections (STIs); 2024."},{"key":"pgph.0006796.ref034","unstructured":"WHO. Multi-drug resistant gonorrhoea [Internet]; 2025 [cited 2026 Jun 17]. Available from: https:\/\/www.who.int\/news-room\/fact-sheets\/detail"},{"issue":"1","key":"pgph.0006796.ref035","first-page":"48","article-title":"Genital tract infections in women attending sexually transmitted infection clinics in Mwanza, north-west Tanzania","volume":"28","author":"SN Buhalata","year":"2013","journal-title":"S Afr J Epidemiol Infect"},{"issue":"2","key":"pgph.0006796.ref036","doi-asserted-by":"crossref","first-page":"91","DOI":"10.3390\/pathogens9020091","article-title":"The laboratory diagnosis of Neisseria gonorrhoeae: current testing and future demands","volume":"9","author":"T Meyer","year":"2020","journal-title":"Pathogens"},{"issue":"2","key":"pgph.0006796.ref037","doi-asserted-by":"crossref","DOI":"10.2196\/17009","article-title":"Antimicrobial resistance of Neisseria gonorrhoeae in a newly implemented surveillance program in Uganda: surveillance report","volume":"6","author":"M Workneh","year":"2020","journal-title":"JMIR Public Health and Surveill"},{"key":"pgph.0006796.ref038","volume-title":"Performance standards for antimicrobial susceptibility testing","author":"Clinical and Laboratory Standards Institute","year":"2025","edition":"35"},{"issue":"10","key":"pgph.0006796.ref039","doi-asserted-by":"crossref","first-page":"1153","DOI":"10.1007\/s40265-021-01530-0","article-title":"Epidemiology, treatments, and vaccine development for antimicrobial-resistant Neisseria gonorrhoeae: current strategies and future directions","volume":"81","author":"EY Lin","year":"2021","journal-title":"Drugs"},{"issue":"5","key":"pgph.0006796.ref040","doi-asserted-by":"crossref","first-page":"697","DOI":"10.1097\/QAD.0000000000003163","article-title":"Curable sexually transmitted infections among women with HIV in sub-Saharan Africa","volume":"36","author":"J Jarolimova","year":"2022","journal-title":"AIDS"},{"key":"pgph.0006796.ref041","doi-asserted-by":"crossref","DOI":"10.3389\/fmicb.2020.01299","article-title":"Intimate relations: molecular and immunologic interactions between Neisseria gonorrhoeae and HIV-1","volume":"11","author":"F Guvenc","year":"2020","journal-title":"Front Microbiol"},{"issue":"2","key":"pgph.0006796.ref042","doi-asserted-by":"crossref","first-page":"188","DOI":"10.1093\/aje\/kwn103","article-title":"A longitudinal study of vaginal douching and bacterial vaginosis--a marginal structural modeling analysis","volume":"168","author":"RM Brotman","year":"2008","journal-title":"Am J Epidemiol"},{"issue":"2","key":"pgph.0006796.ref043","doi-asserted-by":"crossref","first-page":"186","DOI":"10.1093\/aje\/kwi025","article-title":"Douching, pelvic inflammatory disease, and incident gonococcal and chlamydial genital infection in a cohort of high-risk women","volume":"161","author":"RB Ness","year":"2005","journal-title":"Am J Epidemiol"},{"issue":"1","key":"pgph.0006796.ref044","doi-asserted-by":"crossref","first-page":"20325","DOI":"10.1038\/s41598-022-24601-y","article-title":"Hormonal contraceptive use and the risk of sexually transmitted infections: a systematic review and meta-analysis","volume":"12","author":"T Akter","year":"2022","journal-title":"Sci Rep"}],"container-title":["PLOS Global Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pgph.0006796","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T17:45:10Z","timestamp":1788889510000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pgph.0006796"}},"subtitle":[],"editor":[{"given":"Pamela Antonia","family":"Baez Caraballo","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,9,8]]},"references-count":44,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2026,9,8]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pgph.0006796","relation":{},"ISSN":["2767-3375"],"issn-type":[{"value":"2767-3375","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,8]]}}}