Background Neisseria gonorrhoeae (NG) is a major cause of sexually transmitted infection worldwide. Surveillance data from North America suggest that incidence has increased in recent years, after initially falling in the face of intensified control efforts, as antimicrobial resistance in NG has increased. We evaluated the likely mechanisms behind such rebound using simple compartmental models, and explored the implications of such rebound for disease control practice.
Methods We evaluated the impact of risk-focussed treatment strategies on long-term gonorrhoea trends using risk-structured susceptible-infectious-susceptible" (SIS) compartmental models that included and excluded the possibility of antibiotic resistance in gonorrhoea transmission and control. We also examined optimal treatment strategies to minimise gonorrhoea rates when more than one antibiotic is available.
Results Model projections, consistent with previous work, showed that when antibiotic resistance is not possible, strategies that focus on treatment of highest risk individuals (the so-called “core group”), result in collapse of gonorrhoea transmission see Abstract O1-S03.04 figure 1. In contrast, in the presence of antimicrobial resistance, a focus on the core group causes rebound in incidence, with maximal dissemination of antibiotic resistance. When two antibiotics are available for treatment, we found that random assignment of treatment was most effective at delaying rebound in overall rates in the population, while the current strategy, which is to switch first-line treatment when a threshold level of resistance is reached, produced the quickest rebound.
Conclusions While previous models have shown that the targeted treatment of core-group individuals is the most effective at lowering rates of gonorrhoea, our model suggests that core group-focused treatment strategies efficiently disseminate antimicrobial resistant strains of NG, with rebound in gonorrhoea rates. This paradox poses a great dilemma to the control and prevention of gonorrhoea, especially when development of new antibiotic classes has lagged in recent years and vaccine development for gonorrhoea still faces many challenges. Our study highlighted the need for focus on non-antimicrobial strategies for the prevention and control of gonorrhoea.
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