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Abstract
Objectives International travel combined with sex may contribute to dissemination of antimicrobial-resistant (AMR) Neisseria gonorrhoeae (Ng). To assess the role of travel in Ng strain susceptibility, we compared minimum inhibitory concentrations (MICs) for five antibiotics (ie, azithromycin, ceftriaxone, cefotaxime, cefixime and ciprofloxacin) in strains from clients with an exclusively Dutch sexual network and clients with an additional international sexual network.
Methods From 2013 to 2019, we recorded recent residence of sexual partners of clients (and of their partners) with Ng at the Center for Sexual Health of Amsterdam. We categorised clients as having: (1) exclusively sexual partners residing in the Netherlands (‘Dutch only’) or (2) at least one partner residing outside the Netherlands. We categorised the country of residence of sexual partners by World Bank/EuroVoc regions. We analysed the difference of log-transformed MIC of Ng strains between categories using linear or hurdle regression for each antibiotic.
Results We included 3367 gay and bisexual men who had sex with men (GBMSM), 516 women and 525 men who exclusively had sex with women (MSW) with Ng. Compared with GBMSM with a ‘Dutch only’ network, GBMSM with: (1) a Western European network had higher MICs for ceftriaxone (β=0.19, 95% CI=0.08 to 0.29), cefotaxime (β=0.19, 95% CI=0.08 to 0.31) and cefixime (β=0.06, 95% CI=0.001 to 0.11); (2) a Southern European network had a higher MIC for cefixime (β=0.10, 95% CI=0.02 to 0.17); and (3) a sub-Saharan African network had a lower MIC for ciprofloxacin (β=−1.79, 95% CI=−2.84 to −0.74). In women and MSW, higher MICs were found for ceftriaxone in clients with a Latin American and Caribbean network (β=0.26, 95% CI=0.02 to 0.51).
Conclusions For three cephalosporin antibiotics, we found Ng strains with slightly higher MICs in clients with partner(s) from Europe or Latin America and the Caribbean. International travel might contribute to the spread of Ng with lower susceptibility. More understanding of the emergence of AMR Ng is needed.
- NEISSERIA GONORRHOEAE
- TRAVEL
- Sexual Partners
- Drug Resistance, Bacterial
- Disease Transmission, Infectious
Data availability statement
Data are available upon reasonable request. On request to the corresponding author (h.j.devries@amsterdamumc.nl), the following data will be available after publication: de-identified participant data. Data will be shared after approval of an analysis proposal by the first, corresponding and other coauthors (BT, MSvdL, EH, AB, SR, AvD, VWJ, HdV).
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- NEISSERIA GONORRHOEAE
- TRAVEL
- Sexual Partners
- Drug Resistance, Bacterial
- Disease Transmission, Infectious
Data availability statement
Data are available upon reasonable request. On request to the corresponding author (h.j.devries@amsterdamumc.nl), the following data will be available after publication: de-identified participant data. Data will be shared after approval of an analysis proposal by the first, corresponding and other coauthors (BT, MSvdL, EH, AB, SR, AvD, VWJ, HdV).
Footnotes
Handling editor Eric PF Chow
VWJ and HdV contributed equally.
Contributors HdV, AvD and MSvdL designed the study. AvD performed the laboratory analysis. VWJ and BT analysed the data. All authors contributed to the interpretation of the data. BT wrote and drafted the manuscript. All authors critically revised the manuscript. All authors had full access to all the data in the study. VWJ and HdV were the guarantors, and therefore accept full responsibility for the work and/or the conduct of the study, had access to the data, and controlled the decision to publish.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
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Competing interests None declared.
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