Increased density but not prevalence of gametocytes following drug treatment of Plasmodium falciparum

We monitored post-treatment Plasmodium falciparum among patients treated with chloroquine (CQ) and sulfadoxine-pyrimethamine (SP; Fansidar®) in a village in eastern Sudan. Parasites were examined on day 0 (pre-treatment), day 7, day 14 and day 21 (post-treatment) during the transmission season. A further sample was taken 2 months later (day 80) at the start of the dry season. Asexual forms and gametocytes were detected by microscopy, and reverse transcriptase polymerase chain reaction (RT-PCR) was used to detect expression of gametocyte-specific proteins pfs25 and pfg377. Gametocyte carriage, as revealed by microscopy, increased significantly following CQ and SP treatment, reaching a maximum between days 7 and 14. When measured by RT-PCR, however, there was no significant difference in gametocyte rate between day 0 and days 7 or 14. RT-PCR gametocyte rates dropped dramatically by day 80 post treatment but were still 33% and 8% in the CQ- and SP-treated group at this time. Alleles associated with drug resistance of P. falciparum to chloroquine (the chloroquine resistance transporter, pfcrt, and multidrug resistance, pfmdr1) and to pyrimethamine (dihydrofolate reductase, dhfr) were seen at a high frequency at the beginning of treatment and increased further through time following both drug treatments. Infections with drug-resistant parasites tended to have higher gametocyte prevalence than drug-sensitive infections.