Antibiotic-resistant Neisseria gonorrhoeae spread faster with more treatment, not more sexual partners
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Abstract
The sexually transmitted bacterium Neisseria gonorrhoeae has developed resistance to all antibiotic classes that have been used for treatment and strains resistant to multiple antibiotic classes have evolved. In many countries, there is only one antibiotic remaining for empirical N. gonorrhoeae treatment and antibiotic management to counteract resistance spread is urgently needed. Understanding dynamics and drivers of resistance spread can provide rationales for antibiotic management. In our study, we first used antibiotic resistance surveillance data to estimate the rates at which antibiotic-resistant N. gonorrhoeae spread in two host populations, heterosexual men (HetM) and men who have sex with men (MSM). We found higher rates of spread for MSM (0.86 to 2.38 y−1, mean doubling time: 6 months) compared to HetM (0.24 to 0.86 y−1, mean doubling time: 16 months). We then developed a dynamic transmission model to reproduce the observed dynamics of N. gonorrhoeae transmission in populations of heterosexual men and women (HMW) and MSM. We parameterized the model using sexual behavior data and calibrated it to N. gonorrhoeae prevalence and incidence data. In the model, antibiotic-resistant N. gonorrhoeae spread with a median rate of 0.88 y−1 in HMW and 3.12 y−1 in MSM. These rates correspond to median doubling times of 9 (HMW) and 3 (MSM) months. The model shows the difference in the host population’s treatment rate rather than the difference in the number of sexual partners explains the differential spread of resistance. As higher treatment rates result in faster spread of antibiotic resistance, treatment recommendations for N. gonorrhoeae should carefully balance prevention of infection and avoidance of resistance spread.
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2015. Antibiotic-resistant Neisseria gonorrhoeae spread faster with more treatment, not more sexual partners. PeerJ PrePrints 3:e1449v1 https://doi.org/10.7287/peerj.preprints.1449v1Author comment
This is a preprint submission to PeerJ.
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Competing Interests
Christian L Althaus is an Academic Editor for PeerJ.
Author Contributions
Stephanie M Fingerhuth conceived and designed the experiments, performed the experiments, analyzed the data, wrote the paper, prepared figures and/or tables, reviewed drafts of the paper.
Sebastian Bonhoeffer conceived and designed the experiments, analyzed the data, wrote the paper, reviewed drafts of the paper.
Nicola Low conceived and designed the experiments, analyzed the data, wrote the paper, reviewed drafts of the paper.
Christian L Althaus conceived and designed the experiments, analyzed the data, wrote the paper, reviewed drafts of the paper.
Data Deposition
The following information was supplied regarding data availability:
Code is available at github (dx.doi.org/10.5281/zenodo.32179).
Funding
Stephanie M. Fingerhuth, Nicola Low and Christian L. Althaus are funded by SwissTransMed, Platforms for Translational Research in Medicine (25/2013) and Sebastian Bonhoeffer is funded by a European Research Council Advanced Grant (PBDR 268540). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
