Identification of individuals with gonorrhoea within sexual networks: a population-based study

Choudhury, Bhudipa; Risley, Claire; Ghani, Azra C.; Bishop, Cynthia; Ward, Helen; Fenton, Kevin; Ison, Catherine; Spratt, Brian G.

doi:10.1016/s0140-6736(06)69003-x

Cited by 77 publications

(86 citation statements)

References 18 publications

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“…Secondly, when calibrated to give the low incidence rates typical for gonorrhoea in developed Western countries, stratified models may be dependent on one particular demographic stratum, such as the age group with the highest risk activity, to maintain transmission. This is not borne out in molecular epidemiologic data, which instead suggests that distinct strains circulate in multiple sexual networks with very different demographic features (Choudhury et al 2006).…”

Section: Discussionmentioning

confidence: 99%

“…For now, however, we believe we have proposed a model that is capable of explaining the unequal distribution of gonococcal cases which has always been apparent in surveillance data (Health Protection Agency 2005), as well as in more sophisticated geographical and molecular epidemiologic analyses (Monteiro et al 2005;Choudhury et al 2006;Risley et al 2007). We also suggest that our MP framework is a more accurate depiction of epidemiological findings supporting the core group hypothesis (Rothenberg 1983;Potterat et al 1985;Zenilman et al 1999;Bernstein et al 2004), and resolves some of the prior ambiguity about what constitutes the core group for STI transmission ( Thomas & Tucker 1996).…”

Section: Discussionmentioning

confidence: 99%

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A metapopulation modelling framework for gonorrhoea and other sexually transmitted infections in heterosexual populations

Chen

Ghani

Edmunds

2008

J. R. Soc. Interface.

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Gonorrhoea continues to be a public health problem in the UK, and is the second most common bacterial sexually transmitted infection (STI ) after chlamydia. In the UK, gonorrhoea is disproportionately concentrated in epidemiologically distinct subpopulations, with much higher incidence rates in young people, some ethnic minorities and inner city subpopulations. The original model of STI transmission proposed by Hethcote and Yorke explained some of these features through the concept of the 'core group'. Since then, several authors have modified the original model approach to include multiple sexual activity classes, but found this modelling approach to be inadequate when applied to low-prevalence settings such as the UK. We present a metapopulation framework for modelling gonorrhoea and other STIs. The model proposes that the epidemiology of gonorrhoea is largely driven by subpopulations with higher than average concentrations of individuals with high sexual risk activity. We show how this conceptualization of gonococcal epidemiology overcomes key limitations associated with some of the prior efforts to model gonorrhoea. We also use the model to explain several epidemiological features of gonorrhoea, such as its asymmetric distribution across subpopulations, and the contextual risk experienced by members of at-risk subpopulations. Finally, we extend the model to explain the distribution of other STIs, using chlamydia as an example of a more ubiquitous bacterial STI.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

A metapopulation modelling framework for gonorrhoea and other sexually transmitted infections in heterosexual populations

Chen

Ghani

Edmunds

2008

J. R. Soc. Interface.

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“…This limited variation probably reflects ongoing evolution of the same strain only, which also the phylogenetic analysis of the porB1b gene sequences suggested. Most interesting, many isolates of ciprofloxacin-resistant N. gonorrhoeae ST147 were also identified in 2000-2004 in London, England (32,33) and in 2002 in Scotland (34), which may indicate import of this strain to Sweden. In London, England, the transmission of the ciprofloxacin-resistant ST147 isolates was predominantly by homosexual men (32), whereas in Scotland mainly heterosexual transmission occurred (34).…”

Section: Discussionmentioning

confidence: 99%

Molecular characterization of Neisseria gonorrhoeae identifies transmission and resistance of one ciprofloxacin‐resistant strain

Unemo

Sjöstrand

Akhras

et al. 2007

APMIS

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A highly discriminative and objective genetic characterization of N. gonorrhoeae, which increases our knowledge of strain populations in different geographic areas, is crucial for the development of improved control measures. In the present study, conventional phenotypic characterization and genetic characterization by means of pulsed-field gel electrophoresis (PFGE), sequencing of the entire porB gene, N. gonorrhoeae multiantigen sequence typing (NG-MAST), and pyrosequencing of a quinolone resistance determining region (QRDR) of the gyrA gene of Swedish ciprofloxacinresistant N. gonorrhoeae serovar IB-10 isolates (n=45) were performed. The genetic characterization identified one widely spread ciprofloxacin-resistant N. gonorrhoeae ST147 strain. In addition, isolates with slightly different genetic characteristics, which presumably reflect the ongoing evolution only, were also identified. All the isolates contained single nucleotide polymorphisms in QRDR of the gyrA gene that are highly correlated with ciprofloxacin resistance. Consequently, comprehensive characterization identified the first confirmed large domestic transmission, mainly among young heterosexuals, of one ciprofloxacin-resistant N. gonorrhoeae strain in Swedish society during [2002][2003]. In conclusion, a precise, i.e. genetic, characterization for identification of individual strains is a very valuable support to the crucial active surveillance of the epidemiological characteristics and the antibiotic susceptibility of N. gonorrhoeae in the effective treatment of gonorrhoea. KeywordsNeisseria gonorrhoeae; ciprofloxacin resistance; molecular epidemiology; porB gene; NG-MAST Gonorrhoea remains a major sexually transmitted infection (STI) in many countries (1,2). The mainstay in its prevention is based on the availability of effective diagnostics and antibiotic treatment, as well as regional, national, and international surveillance of the epidemiological characteristics and the antibiotic susceptibility of the etiological agent, i.e. Neisseria gonorrhoeae. Nowadays, a high level of decreased susceptibility or resistance to most traditional antibiotics used for treatment of gonorrhoea has been identified in most countries [2][3][4][5]). In addition, the characteristics of circulating N. gonorrhoeae strains fluctuate over time and a highly discriminative and objective characterization, i.e. genetic typing, of the bacteria, is crucial. This genetic typing may identify the transmission of more virulent and/or antibiotic-resistant strains, information that is important for the development of improved control measures. Conventional phenotypic characterization of N. gonorrhoeae strains has several limitations (6-10) and many genetic methods have been developed to overcome these shortcomings (11).Since 1997 the incidence of gonorrhoea in Sweden has increased almost annually (Gonorrhoea/ year and month statistics per county http://gis.smittskyddsinstitutet.se/mapapp/build/intro_eng.html (3,8)). According to previous studies (8,10,12), the transmi...

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“…As a result, gonococcal populations are made up of multiple, constantly evolving subtypes. Molecular-based studies [2][3][4] have shown that only small numbers of "successful" subtypes (usually specific to particular sexual networks) predominate and persist. A spread of multidrug-resistant gonococci occurs when these successful subtypes also acquire resistance genes.…”

mentioning

confidence: 99%

Multidrug-resistant Neisseria gonorrhoeae

Tapsall¹

2009

Canadian Medical Association Journal

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Identification of individuals with gonorrhoea within sexual networks: a population-based study

Cited by 77 publications

References 18 publications

A metapopulation modelling framework for gonorrhoea and other sexually transmitted infections in heterosexual populations

A metapopulation modelling framework for gonorrhoea and other sexually transmitted infections in heterosexual populations

Molecular characterization of Neisseria gonorrhoeae identifies transmission and resistance of one ciprofloxacin‐resistant strain

Multidrug-resistant Neisseria gonorrhoeae

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