AB Alawattegama

Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, England, United Kingdom

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Publications (7)11.66 Total impact

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    ABSTRACT: This study aimed to investigate the origin of high-level azithromycin resistance that emerged in isolates of Neisseria gonorrhoeae in England and Wales in 2007, and to establish methods for identifying high-level azithromycin resistance. The Gonococcal Resistance to Antimicrobials Surveillance Programme (GRASP) data from 2001-07 were examined for emerging trends in azithromycin susceptibility. Further to the identification of six high-level azithromycin-resistant isolates in GRASP 2007, an additional 102 isolates were selected on the basis of azithromycin susceptibility and geographic origin from the GRASP 2006 and 2007 collections. Susceptibility testing by Etest and disc diffusion was performed on all 108 isolates and 75 of these were typed by N. gonorrhoeae multiantigen sequence typing. A slight drift towards higher MICs of azithromycin was observed in the gonococcal population since 2001. Of greater concern was the first example of a shift to high-level resistance observed in six isolates in 2007. All six isolates were sequence type 649, which was not observed in any of the lower-level azithromycin-resistant isolates from 2007 or in any isolates tested from the same geographical locations. Contact tracing data for one patient suggested a link with Scotland. Disc diffusion testing of all 108 isolates showed that azithromycin, but not erythromycin, discs can differentiate between low-level and high-level resistance. High-level azithromycin resistance has emerged in England and Wales. Contact tracing and typing data suggest this may have originated from Scotland. Surveillance of azithromycin resistance will be key in controlling its further dissemination.
    Journal of Antimicrobial Chemotherapy 06/2009; 64(2):353-8. DOI:10.1093/jac/dkp188 · 5.44 Impact Factor
  • M Yong, S Wessels, A B Alawattegama, Kathy Jones
    International Journal of STD & AIDS 10/2007; 18(9):649. DOI:10.1258/095646207781568619 · 1.04 Impact Factor
  • AB Alawattegama, S Rajamanoharan, R Maw, CA Carne
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    ABSTRACT: A questionnaire was circulated to all lead genitourinary (GU) medicine physicians in the UK in November 2003 to obtain data on access, waiting times and triaging. Of the 143 responders, 92.3% departments had limited access to some or all GU medicine clinics. Where access was limited, 5.3% had no identifiable process in place to see urgent patients. The mean waiting times in clinics with an open appointment system only for a routine female and male appointment were 2.9 weeks and 2.8 weeks (range 2 days-10 weeks), respectively, and for an urgent appointment, two days (range same day-14 days), for both sexes. The survey has raised concerns that a number of departments did not consider as urgent for prioritizing, patients with documented untreated gonorrhoea, syphilis, or HIV, or contacts of patients with these conditions. This survey has highlighted a need for the national specialist society to provide guidance on prioritizing patients where access is limited.
    International Journal of STD & AIDS 05/2006; 17(4):230-3. DOI:10.1258/095646206776253381 · 1.04 Impact Factor
  • W Wasef, S Hughes, H Sugunendran, A Alawattegama
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    ABSTRACT: This audit was conducted to look into the necessity of testing urine threads, in the diagnosis of non-gonococcal urethritis (NGU). In a sample of 280 NGU cases, it was found that in 8.8% of cases there was a risk of the diagnosis being missed, should Gram-stained urethral smears be totally relied on. The study showed that examining urine threads is beneficial in diagnosing NGU, especially, in symptomatic men with negative Gram-stained urethral smears. It should be noted, however, that in the group of patients studied for this audit, urine threads testing did not detect any chlamydia-positive NGU cases.
    International Journal of STD & AIDS 08/2005; 16(7):504. DOI:10.1258/0956462054308413 · 1.04 Impact Factor
  • W Wasef, H Sugunendran, A Alawattegama
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    ABSTRACT: Genital warts are the commonest sexually transmitted viral infection seen in genitourinary medicine clinics. As common as warts are, with extensive previous studies, literature searches on genital warts in transsexuals were unfruitful. Due to the nature and rarity of such a case, it was felt that it would be interesting to detail its management.
    International Journal of STD & AIDS 06/2005; 16(5):388-9. DOI:10.1258/0956462053888871 · 1.04 Impact Factor
  • J E Corkill, C Kelly, T Neal, AB Alawattegama, CA Hart
    International Journal of STD & AIDS 02/2005; 16(1):83. DOI:10.1258/0956462052932791 · 1.04 Impact Factor
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    ABSTRACT: Ciprofloxacin-resistant Neisseria gonorrhoeae had been rarely detected on Merseyside and when found was associated with beta-lactamase producing strains, imported from abroad. However, in August 2000, two cases of infection with ciprofloxacin-resistant beta-lactamase-negative strains occurred in sexually unrelated patients with no history of foreign travel. Over the next 18 months a total of 120 patients presented with ciprofloxacin-resistant gonococci, from which 99 patient strains were available for study. Gonococcal DNA was subjected to molecular fingerprinting by polymerase chain reaction amplification followed by Taq1 digestion of their opa genes. Twelve differing opa-types were found, but 79 patients were infected with a single genotype, opa-type 1. The sexual histories of the majority of this group indicated acquisition in Merseyside. This endemic strain was further characterized by having the same amino acid substitutions on gyrA and parC genes. An endemic clone of ciprofloxacin-resistant N. gonorrhoeae has been established on Merseyside necessitating the introduction of ceftriaxone as first-line treatment. Despite the presence of 11 other clones in the city, opa type-1 strains have not yet been displaced, raising the possibility that this strain is endowed with added virulence/endemicity traits or that a number of source patients have not yet been found.
    International Journal of STD & AIDS 07/2003; 14(6):379-85. DOI:10.1258/095646203765371259 · 1.04 Impact Factor

Publication Stats

65 Citations
11.66 Total Impact Points


  • 2003–2006
    • Royal Liverpool and Broadgreen University Hospitals NHS Trust
      • Department of Genitourinary Medicine
      Liverpool, England, United Kingdom