Developing a model to predict individualised treatment for gonorrhoea: a modelling study

Abstract

ObjectiveTo develop a tool predicting individualised treatment for gonorrhoea, enabling treatment with previously recommended antibiotics, to reduce use of last-line treatment ceftriaxone.DesignA modelling study.SettingEngland and Wales.ParticipantsIndividuals accessing sentinel health services.InterventionDeveloping an Excel model which uses participants’ demographic, behavioural and clinical characteristics to predict susceptibility to legacy antibiotics. Model parameters were calculated using data for 2015–2017 from the Gonococcal Resistance to Antimicrobials Surveillance Programme.Main outcome measuresEstimated number of doses of ceftriaxone saved, and number of people delayed effective treatment, by model use in clinical practice. Model outputs are the predicted risk of resistance to ciprofloxacin, azithromycin, penicillin and cefixime, in groups of individuals with different combinations of characteristics (gender, sexual orientation, number of recent sexual partners, age, ethnicity), and a treatment recommendation.ResultsBetween 2015 and 2017, 8013 isolates were collected: 64% from men who have sex with men, 18% from heterosexual men and 18% from women. Across participant subgroups, stratified by all predictors, resistance prevalence was high for ciprofloxacin (range: 11%–51%) and penicillin (range: 6%–33%). Resistance prevalence for azithromycin and cefixime ranged from 0% to 13% and for ceftriaxone it was 0%. Simulating model use, 88% of individuals could be given cefixime and 10% azithromycin, saving 97% of ceftriaxone doses, with 1% of individuals delayed effective treatment.ConclusionsUsing demographic and behavioural characteristics, we could not reliably identify a participant subset in which ciprofloxacin or penicillin would be effective. Cefixime resistance was almost universally low; however, substituting ceftriaxone for near-uniform treatment with cefixime risks re-emergence of resistance to cefixime and ceftriaxone. Several subgroups had low azithromycin resistance, but widespread azithromycin monotherapy risks resistance at population level. However, this dataset had limitations; further exploration of individual characteristics to predict resistance to a wider range of legacy antibiotics may still be appropriate.

Histories of ‘a loathsome disease’: Sexual health in modern Britain

“…In 2019 the House of Commons Health and Social Care Committee reported that falling overall STI rates mask persistent challenges among, for example, young adults, racially minoritised communities and transgender people. Antimicrobial resistance is also fast becoming a serious problem when treating diseases like gonorrhoea (Findlater, 2021;Fitzpatrick, 2015;Gradmann, 2013;Leanord, 2021;Podolsky, 2010Podolsky, , 2015Spiteri et al, 2019;Unemo et al, 2019). Much more needs to be done to meet trans sexual-health needs (Hibbert et al, 2019;D.…”

“…In 2019 the House of Commons Health and Social Care Committee reported that falling overall STI rates mask persistent challenges among, for example, young adults, racially minoritised communities and transgender people. Antimicrobial resistance is also fast becoming a serious problem when treating diseases like gonorrhoea (Findlater, 2021; Fitzpatrick, 2015; Gradmann, 2013; Leanord, 2021; Podolsky, 2010, 2015; Spiteri et al., 2019; Unemo et al., 2019). Much more needs to be done to meet trans sexual‐health needs (Hibbert et al., 2019; D. Richardson et al., 2020), tackle long‐standing health inequalities, overcome structural and cultural barriers to pre‐exposure prophylaxis (Nagington & Sandset, 2020; Nakasone et al., 2020) and build more nuanced, less‐judgmental understandings of high‐risk behaviours like chemsex (Blomquist et al., 2020; Hegazi et al., 2016; Moyle, 2020; Pollard et al., 2017).…”