Article Text

Download PDFPDF
Short report
Association between STI screening intensity in men who have sex with men and gonococcal susceptibility in 21 States in the USA: an ecological study
  1. Christophe Van Dijck1,
  2. Jolein Laumen1,
  3. Maria Zlotorzynska2,
  4. Sheeba Santhini Manoharan-Basil1,
  5. Chris Kenyon1,3
  1. 1 Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
  2. 2 Department of Epidemiology, Rollins School of Public Health, Atlanta, Georgia, USA
  3. 3 Department of Medicine, University of Cape Town, Cape Town, South Africa
  1. Correspondence to Dr Christophe Van Dijck, Department of Clinical Sciences, Institute of Tropical Medicine, Antwerpen, Belgium; cvandijck{at}


Objectives Antimicrobial resistance is generally linked to antimicrobial selection pressure. Antimicrobial-resistant Neisseria gonorrhoeae infections frequently emerge in core groups. We hypothesised that these groups are more often exposed to antimicrobials as a consequence of the repeated treatment of both symptomatic and asymptomatic sexually transmitted infections (STIs) and that frequent STI screening in asymptomatic patients may contribute indirectly to antimicrobial exposure. In this study, we explored the ecological association between screening intensity in men who have sex with men and antimicrobial susceptibility in N. gonorrhoeae in the USA.

Methods Data on STI screening intensity came from the American Men’s Internet Survey between October 2014 and March 2015. Data on gonococcal susceptibility to azithromycin, ceftriaxone and cefixime were used from the Gonococcal Isolate Surveillance Project in 2015. Spearman’s correlation was used to determine the association between these two variables.

Results A positive ecological association was found between STI screening intensity and geometric mean gonococcal minimum inhibitory concentration for ceftriaxone (rho=0.42, p=0.031) and cefixime (rho=0.42, p=0.029), but not for azithromycin (rho=0.31, p=0.11). The above results must be interpreted with caution as many limitations apply.

Conclusions Variation in STI screening intensity may contribute to differences in gonococcal resistance between States in the USA.

  • Neisseria gonorrhoeae
  • ecological association
  • antimicrobial resistance
  • screening
  • men who have sex with men

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Handling editor Deborah Williamson

  • Contributors CK conceptualised, drafted and revised the paper. CVD analysed the data, drafted and revised the paper. JL and SSM-B revised the paper. MZ provided the data from AMIS-2014 and revised the paper.

  • 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.

  • Competing interests None declared.

  • Patient consent for publication Not required.

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

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.