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Identifying factors that lead to the persistence of imported gonorrhoeae strains: a modelling study
  1. Ben B Hui1,
  2. David M Whiley2,
  3. Basil Donovan1,3,
  4. Matthew G Law1,
  5. David G Regan1
  6. on behalf of the GRAND Study Investigators
    1. 1The Kirby Institute, UNSW Australia, Sydney, New South Wales, Australia
    2. 2University of Queensland Centre for Clinical Research, University of Queensland, Brisbane, Queensland, Australia
    3. 3Sydney Sexual Health Centre, Sydney Hospital, Sydney, New South Wales, Australia
    1. Correspondence to Dr Ben B Hui, Biostatistics and Database Program, The Kirby Institute, UNSW Australia, Wallace Wurth Building, Sydney, NSW 2052, Australia; bhui{at}kirby.unsw.edu.au

    Abstract

    Objective The importation of Neisseria gonorrhoeae (NG) strains from overseas is believed to be the main source of antimicrobial resistance in Australia. With recent sporadic cases of ceftriaxone-resistant gonorrhoea reported in Australia and elsewhere, we sought to model the potential for imported NG strains to persist in the men who have sex with men (MSM) population in Australia.

    Methods We developed an individual-based model to simulate the transmission of NG in a population of urban MSM, and used this model to investigate factors contributing to the probability that an imported NG strain will persist.

    Results The probability of the imported NG strain persisting as the result of a single importation event is less than 1%, but the probability increases to 1% if the imported NG strain is resistant to treatment, and further increases to 3.1% if the imported NG strain can also form mixed infections with the local NG strain. The probability of the imported NG strain persisting increases to 4.4% if there are at least three importation events per month within a 1-year period.

    Conclusion The imported NG strain is unlikely to persist as a result of a single importation event. However, the probability of persistence increases if the imported NG strain is resistant to treatment, can form mixed infections with the local NG strain or there are frequent importation events. Identification of the factors that determine the likelihood of persistence of an imported NG strain could contribute to our capacity to respond appropriately and in a timely fashion.

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    Footnotes

    • Handling editor Jackie A Cassell

    • Collaborators The Chief Investigators on the GRAND Study are David Whiley, David Regan, Basil Donovan, Marcus Chen (Monash University), Rebecca Guy (UNSW Australia) and Monica Lahra (UNSW Australia). Only the listed authors (Hui, Whiley, Donovan, Regan) were involved in the modelling study described in this paper.

    • Contributors BBH participated in the design of the study, the development and implementation of the model, data analysis and drafting of the manuscript. DMW participated in the design of the study and provided laboratory background. BD participated in the design of the study and provided his knowledge and expertise on gonorrhoea. DGR participated in the design of the study, the analysis of data and drafting of the manuscript. All authors read and approved the final manuscript.

    • Funding This study was funded in part by the Gonorrhoea Resistance Assessment by Nucleic Acid Detection Study (GRAND; National Health and Medical Research Council project grant number 1025517). The Chief Investigators on the GRAND Study are David Whiley, David Regan, Basil Donovan, Marcus Chen (Monash University), Rebecca Guy (UNSW Australia) and Monica Lahra (UNSW Australia). Only the listed authors (Hui, Whiley, Donovan, Regan) were involved in the modelling study described in this paper. The Kirby Institute is funded by the Australian Government Department of Health and Ageing and is affiliated with the Faculty of Medicine, University of New South Wales.

    • Competing interests None.

    • Provenance and peer review Not commissioned; externally peer reviewed.

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