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Epidemiological impact of Neisseria gonorrhoeae and Chlamydia trachomatis screening in men having sex with men: a modelling study
  1. Julien Flaig1,
  2. Laurent Hocqueloux2,
  3. Romain Palich3,
  4. Lise Cuzin4,
  5. Olivier Robineau5,
  6. Pascal Pugliese6,
  7. Cyrille Delpierre7,
  8. Nicolas Voirin1,
  9. Laurent Cotte8
  10. Dat'AIDS Study Group
    1. 1EPIMOD, Lyon, France
    2. 2Infectious Diseases, CHU d'Orléans, Orléans, France
    3. 3Department of Infectious Diseases, Sorbonne Université, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique (iPLESP), AP-HP, Pitié Salpêtrière Hospital, Paris, France
    4. 4CHU de Martinique, Fort-de-France, Martinique
    5. 5CH Gustave Dron de Tourcoing, Tourcoing, France
    6. 6Corevih, CHU de Nice, Côte d'Azur University, Nice, France
    7. 7CERPOP, Université Toulouse III-Paul Sabatier, Toulouse, France
    8. 8Infectious Diseases, Hopital de la Croix-Rousse, Lyon, France
    1. Correspondence to Dr Laurent Hocqueloux, Infectious Diseases, CHU d'Orléans, Orléans 45100, France; laurent.hocqueloux{at}chu-orleans.fr

    Abstract

    Objectives The impact of the systematic screening of Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) in men having sex with men (MSM) on these pathogens’ epidemiology remains unclear. We conducted a modelling study to analyse this impact in French MSM.

    Methods We modelled NG and CT transmission using a site-specific deterministic compartmental model. We calibrated NG and CT prevalence at baseline using results from MSM enrolled in the Dat’AIDS cohort. The baseline scenario was based on 1 million MSM, 40 000 of whom were tested every 90 days and 960 000 every 200 days. Incidence rate ratios (IRRs) at steady state were simulated for NG, CT, NG and/or CT infections, for different combinations of tested sites, testing frequency and numbers of frequently tested patients.

    Results The observed prevalence rate was 11.0%, 10.5% and 19.1% for NG, CT and NG and/or CT infections. The baseline incidence rate was estimated at 138.2 per year per 100 individuals (/100PY), 86.8/100PY and 225.0/100PY for NG, CT and NG and/or CT infections. Systematically testing anal, pharyngeal and urethral sites at the same time reduced incidence by 14%, 23% and 18% (IRR: 0.86, 0.77 and 0.82) for NG, CT and NG and/or CT infections. Reducing the screening interval to 60 days in frequently tested patients reduced incidence by 20%, 29% and 24% (IRR: 0.80, 0.71 and 0.76) for NG, CT and NG and/or CT infections. Increasing the number of frequently tested patients to 200 000 reduced incidence by 29%, 40% and 33% (IRR: 0.71, 0.60 and 0.67) for NG, CT and NG and/or CT infections. No realistic scenario could decrease pathogens’ incidence by more than 50%.

    Conclusions To curb the epidemic of NG and CT in MSM, it would not only be necessary to drastically increase screening, but also to add other combined interventions.

    • NEISSERIA GONORRHOEAE
    • Chlamydia Infections
    • Epidemiology
    • Models, Statistical

    Data availability statement

    All data relevant to the study are included in the article or uploaded as supplemental information.

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    Data availability statement

    All data relevant to the study are included in the article or uploaded as supplemental information.

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    Footnotes

    • Handling editor Eric PF Chow

    • Correction notice This article has been corrected since it was first published online. The Dat'AIDS Study Group has been added as an author.

    • Contributors JF, LH, RP, LCu, OR, PP, CD, NV and LCo designed the study. LCo collected and prepared the data. JF, NV and LCo prepared the modelling study. JF and NV performed the modelling study. LCo and LH redacted the draft manuscript. JF, RP, LCu, LH, OR, PP, CD, NV and LCo revised the manuscript. JF accepts 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.

    • Competing interests None declared.

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

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.