Introduction Antibiotic resistance threatens to make Neisseria gonorrhoeae untreatable. Point-of-care tests (POC) that detect antimicrobial resistance (AMR) would allow individually tailored treatment. But rapid access to test results might lead to more treatment overall, resulting in higher resistance levels. We investigated the impact of different clinical pathways for gonorrhoea diagnosis on the spread of AMR gonorrhoea.
Methods We used data about the prevalence and incidence of gonorrhoea in men who have sex with men (MSM) and heterosexual men and women (HMW) to calibrate a mathematical model that describes the transmission of N. gonorrhoeae. With this model, we simulated four clinical pathways for the diagnosis and treatment of gonorrhoea: POC test for N. gonorrhoeae with AMR detection (POC+R), POC without AMR detection (POC-R), culture with antimicrobial susceptibility testing (culture), and laboratory-based nucleic acid amplification tests without AMR detection (NAAT). We calculated the proportion of resistant infections, the cases averted after 5 years, and compared how fast resistant infections spread in the populations.
Results After 30 years, the proportion of resistant N. gonorrhoeae infections is lowest for POC+R (median MSM: 0.18%, HMW: 0.12%), and increases for culture, NAAT, and POC-R. After 5 years, NAAT leads to a total of 36 366 (median MSM) and 1228 (median HMW) observed cases per 1 00 000 persons. POC+R results in the largest number of cases averted after 5 years (median MSM: 3,353, HMW: 118 per 1 00 000 persons) compared with NAAT. POC tests with intermediate sensitivity for the detection of AMR slow the spread of resistance more than NAAT. POC tests require very high sensitivity to detect AMR to reduce the spread of AMR more than culture.
Conclusion POC tests with high sensitivity to detect AMR can keep gonorrhoea treatable for longer than either culture or NAAT. POC tests that do not detect AMR reliably should not be introduced because they result in higher levels of empirical treatment for gonorrhoea and accelerate the spread of AMR.