Introduction Increasing antibiotic resistance limits treatment for gonorrhoea. We examined the extent to which a hypothetical point-of-care (POC) test reporting antibiotic susceptibility profiles could delay emergence of resistance and prolong effectiveness of existing antibiotics.

Methods We developed a deterministic compartmental model describing gonorrhoea transmission in a risk-stratified single-sex population with three different antibiotics available to treat infections. Probabilities of resistance emergence on treatment and fitness costs associated with resistance were based on characteristics of fluoroquinolones, azithromycin, and ceftriaxone, as inferred from a previous phylogenomic analysis. We compared strategies in which a POC test was used to guide therapy in varying proportions of cases against the current empiric approach (dual treatment with azithromycin plus ceftriaxone).

Results Based on current estimates of gonoccoal susceptibility patterns in the United States, the model indicated that continued empiric dual antibiotic treatment without POC testing resulted in >5% of isolates being resistant to both azithromycin and ceftriaxone within 15 years. When POC testing was used in 10% of identified cases, this time was delayed by 4 years, while time to reach a 1% prevalence of triply-resistant strains was delayed by 5 years. With POC testing in >55% of identified cases, it took over 100 years for dual and triple resistance to exceed 1%, and with POC testing in ≥75% of cases, strains resistant to azithromycin and/or ceftriaxone did not persist in the population. Results were sensitive to assumptions about fitness costs and test sensitivity only when POC test deployment was relatively low (<25%).

Conclusion Rapid diagnostics that indicate antibiotic susceptibility have the potential to extend the usefulness of existing antibiotics for treatment of gonorrhoea. More broadly, integration of evidence on fitness costs associated with resistance can enhance strategies for rational antibiotic selection and further delay emergence of resistance.