Rethinking Screening Intensity in Terms of Reducing Prevalence or Increasing Selection Pressure for the Emergence of Resistant Gonorrhea: A Modeling Study of Men Who Have Sex With Men in Belgium

Abstract

Background Neisseria gonorrhoeae (NG) has developed antibiotic resistance (AMR) to multiple classes of antibiotics. While treatment of symptomatic NG in groups, like men who have sex with men (MSM) is crucial, screening programs targeting asymptomatic NG cases may contribute to excessive antibiotic exposure of the population and thus to the emergence of gonococcal AMR. Our primary aim was to assess if intense screening could promote AMR in NG. Methods We built a network-based model of NG transmission dynamics among MSM in Belgium to estimate the prevalence of NG in the population and the risk of AMR. The model simulates daily transmission of NG among three anatomical sites in a population of 10000 MSM, grouped as low- or high-risk, over 10 years. The effect of group-wise variation in treatment efficacy levels and screening intensities on NG prevalence and cumulative risk of AMR emergence was evaluated. Results Increasing screening intensity in the low-risk MSM had little effect on NG prevalence. An inverse correlation between screening intensity in the high-risk group and both NG prevalence and the risk for azithromycin resistance was observed, irrespective of the screening intensity in the low-risk group. High-risk MSM were at higher risk for azithromycin-resistant NG in all screening intensity and treatment efficacy scenarios, compared to low-risk MSM. Discussion Our results suggest that intensive screening in the low-risk population has little impact on prevalence but may increase the probability of AMR emerging. In contrast, intensive screening in the high-risk population reduces both the prevalence of NG and macrolide resistance.

Microbisporicin (NAI-107) protects Galleria mellonella from infection with Neisseria gonorrhoeae

“…lactis IL1403 ( n = 1) (Table 2). In Belgium, resistance to gonococcal azithromycin has increased from 0.2% to 18.6% over the past 8 years, despite the use of dual therapy, i.e., ceftriaxone and azithromycin ( 49 ). Therefore, in this study, the WHO-P N. gonorrhoeae isolate was used in the initial in vitro screening and in vivo experiments due to its susceptibility to ceftriaxone (0.004 µg/mL) and resistance to azithromycin (4 µg/mL), as determined by the European Committee on Antimicrobial Susceptibility Testing (EUCAST) criteria ( 50 ).…”

STI pathogens in the oropharynx: update on screening and treatment

“…nonpathogenic Neisseria species) [90 ▪ ,91,92], and microbiome [93,94]. Although reducing screening can improve antimicrobial stewardship [95 ▪ ], this may lead to some fear and concerns from the MSM community. An Australian qualitative study among 13 MSM using HIV PrEP found that they were aware of the concern of antibiotic resistance but they would still want the 3-monthly asymptomatic STI screening to ensure their safety and there was a fear of the rise of STIs in their community if they were screened less frequently [96 ▪ ].…”

Estimating Partnership Duration among MSM in Belgium—A Modeling Study

“…Several modeling studies have described the transmission of CT and NG among MSM [ 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 ], which cluster in a few Western countries, mainly from the US [ 9 , 13 , 14 , 19 , 25 , 26 , 27 , 28 , 35 , 36 ] and Australia [ 18 , 22 , 23 , 24 , 32 , 40 , 41 , 42 , 43 ]. In Europe, notable modeling studies have been conducted in the UK [ 31 , …”

“…In Europe, notable modeling studies have been conducted in the UK [ 31 , 37 , 38 , 45 ] and The Netherlands [ 17 , 29 , 30 , 33 , 39 , 44 ], with few papers from France [ 34 ], Belgium [ 8 , 16 ] and Switzerland [ 20 , 21 ]. The majority of the published models from Europe are compartmental models, with only a hand-full of models using individual-based or network models [ 8 , 16 , 29 , 30 , 39 , 45 ]. While the usefulness of compartmental models is undeniable, they lack both the complexity of the transmission mechanisms of STIs and the fine-grain detail of individual characteristics that individual-based and network models exhibit.…”

“…Many models mention the lack of parameters in the literature to inform simulation models, leading to limitations in the validity and interpretation of the results [ 8 , 16 , 17 , 18 , 26 , 29 , 32 , 34 , 35 , 40 , 41 , 43 , 45 ]. Besides transmission probabilities that are difficult to calculate in a clinical setting, high-quality clinical parameters such as the probability of symptoms and time intervals until recovery are not readily available in the literature, especially when reported by different anatomical sites [ 46 , 47 ].…”