Does gonorrhoea screening intensity play a role in the early selection of antimicrobial resistance in men who have sex with men (MSM)? A comparative study of Belgium and the United Kingdom

Abstract

Background: It is unclear why antimicrobial resistance in Neisseria gonorrhoeae in the United Kingdom (UK) and the United States has tended to first appear in men who have sex with men (MSM). We hypothesize that increased exposure to antimicrobials from intensive STI screening programmes plays a role. Methods: We assess if there is a difference in the distribution of azithromycin, cefixime and ceftriaxone minimum inhibitory concentrations (MICs) between MSM and women in the United Kingdom (UK) where 70% of MSM report STI screening in the past year vs. Belgium where 9% report STI screening in the past year. Our hypothesis is that MICs of the MSM should be higher than those of the women in the UK but not Belgium. Data for the MICs were taken from the Gonococcal Resistance to Antimicrobials Surveillance Programme (GRASP) in the UK in 2010/2011 and 2014 and a similar national surveillance programme in Belgium in 2013/2014 (the first most complete available data). We used the Mann–Whitney test to compare the MIC distributions between MSM and women within each country Results: In the UK the MICs for all three antimicrobials were significantly higher in MSM than women at both time points (P all <0.0005). In Belgium only the MIC distribution for azithromycin was higher in MSM (P<0.0005). Conclusion: The findings for cefixime and ceftriaxone, but not azithromycin are compatible with our hypothesis that screening-intensity could contribute to the emergence of AMR. Numerous other interpretations of our results are discussed.

Toward a Set of Criteria to Decide Which STIs to Screen for in PrEP Cohorts

“…One analysis found that 3 ×3 screening in PrEP cohorts results in macrolide exposures that are strongly associated with the induction of AMR in a range of bacteria (10). Two ecological analyses have found positive associations between the intensity of gonorrhea/chlamydia screening and the prevalence of AMR in N. gonorrhoeae (29, 30).…”

Novel strategies for prevention and treatment of antimicrobial resistance in sexually-transmitted infections

“…In addition, the transition from culture-based diagnostics to highly sensitive nucleic acid amplification tests (NAAT) for genital and extragenital sites has led to increased detection of STIs [34]. The recommendation for frequent screening of high-risk populations such as MSM taking HIV PrEP, comprising comprehensive testing of genital and extragenital sites using highly sensitive NAAT has also contributed to increased rates of STIs detected in these populations [35 ▪ ,36]. As the gold standard diagnostic assay for key STIs including N. gonorrhoeae , C. trachomatis , M. genitalium and the herpes simplex viruses, highly sensitive NAAT assays are a key tool in the diagnosis of STIs.…”

“…As the gold standard diagnostic assay for key STIs including N. gonorrhoeae , C. trachomatis , M. genitalium and the herpes simplex viruses, highly sensitive NAAT assays are a key tool in the diagnosis of STIs. However, their limitations must be noted, in particular the lack of comprehensive antimicrobial resistance detection [11 ▪▪ ] and the potential for frequent screening strategies to drive increased antimicrobial use and antimicrobial resistance [36,37].…”