Introduction People living in Britain who have sex abroad are more likely to report sexual behaviour that puts them at greater risk of acquiring STIs, including Neisseria gonorrhoeae (NG). Antimicrobial resistant (AMR) NG is a global public health concern, which may emerge de novo or be imported to the UK when individuals infected abroad have subsequent sexual partners at home. We investigated whether patients who reported sex outside the UK (‘sex abroad’) were more or less likely to be diagnosed with AMR NG.
Methods Logistic regression was used to model the association between reported recent sex abroad and decreased susceptibility (DS) to ceftriaxone (MIC (mg/L)>0.015) and cefixime (0.125) and azithromycin AMR (>1) stratifying by sexual orientation (men who have sex with men (MSM) and heterosexual men and women) from isolates in England and Wales collected within the Gonococcal Resistance to Antimicrobials Surveillance Programme, 2004–2015.
Results Over 10% of MSM and heterosexuals reported sex abroad. Among heterosexuals, infection with a strain of NG with DS to ceftriaxone was associated with sex abroad after adjusting for potential confounders: ceftriaxone (DS prevalence, adjusted odds ratio (95% confidence interval)): 14%, 1.8 (1.3–2.3). Infection with NG DS/AMR to cefixime or azithromycin was not associated with reported sex abroad after adjusting for potential confounders: cefixime 4%, 1.6 (0.9–2.7); azithromycin 2%, 1.5 (0.7–3.3). For MSM, no association was found between infections with DS/AMR NG and sex abroad.
Conclusion In the UK, heterosexuals with NG infection who report sex abroad are at a higher risk of DS to ceftriaxone, suggesting that sex abroad might be the source of some AMR NG within heterosexual networks and highlighting the importance of condom use for travellers. In contrast, DS/AMR NG was not associated with sex abroad among MSM, which might reflect established AMR within MSM networks in the UK. Genetic comparison of these isolates using whole genome sequencing might further elucidate how AMR NG is imported and disseminated in the UK.
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