Effects of Sexual Network Connectivity and Antimicrobial Drug Use on Antimicrobial Resistance inNeisseria gonorrhoeae

Abstract

Contemporary strategies to curtail the emergence of antimicrobial resistance in Neisseria gonorrhoeae include screening for and treating asymptomatic infections in high-prevalence populations in whom antimicrobial drug–resistant infections have typically emerged. We argue that antimicrobial resistance in these groups is driven by a combination of dense sexual network connectivity and antimicrobial drug exposure (for example, through screen-and-treat strategies for asymptomatic N. gonorrhoeae infection). Sexual network connectivity sustains a high-equilibrium prevalence of N. gonorrhoeae and increases likelihood of reinfection, whereas antimicrobial drug exposure results in selection pressure for reinfecting N. gonorrhoeae strains to acquire antimicrobial resistance genes from commensal pharyngeal or rectal flora. We propose study designs to test this hypothesis.

Commensal Neisseria Are Shared between Sexual Partners: Implications for Gonococcal and Meningococcal Antimicrobial Resistance

“…Twenty-eight percent of samples had reduced susceptibility to ceftriaxone (minimum inhibitory concentration ≥0.125 mg/L) [4]. The reason for the high prevalence of commensal Neisseria with reduced antimicrobial susceptibility in these groups of patients presumably parallels the one proposed for gonorrhea: repeated cycles of reinfection/recolonization and antimicrobial exposure in individuals within a highly connected transmission-network [31].…”

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

“…There are a number of alternative explanations for why AMR may arise sooner in MSM than women. MSM may be more likely to travel abroad and acquire more resistant NG in this way 4,30 . MSM are more likely to be HIV-infected and may as a result use more antimicrobials 4 .…”

“…MSM may be more likely to travel abroad and acquire more resistant NG in this way 4,30 . MSM are more likely to be HIV-infected and may as a result use more antimicrobials 4 . Some studies have found that even after stratifying for HIV-infection status, MSM still report consuming more antimicrobials 4 .…”

“…A striking feature of the patterning of antimicrobial resistance (AMR) is how it has repeatedly emerged in core-groups, either sex workers or men who have sex with men (MSM) with high rates of partner change 1 . In the last two decades AMR in the United Kingdom (UK) and the United States (USA) has tended to first appear in MSM [2][3][4][5] . In the UK for example, the prevalence of cefixime resistance (following the switch to cefixime therapy for Neisseria gonorrhoeae (NG) in 2005) increased from 0% in 2005 to 33.1% in 2010 in MSM, whilst remaining under 7% in heterosexual men and women (Figure 1) 2 .…”

“…In the UK for example, the prevalence of cefixime resistance (following the switch to cefixime therapy for Neisseria gonorrhoeae (NG) in 2005) increased from 0% in 2005 to 33.1% in 2010 in MSM, whilst remaining under 7% in heterosexual men and women (Figure 1) 2 . In the USA, UK and the Netherlands, the prevalence of AMR to at least one of ciprofloxacin/cefixime/cefotaxime/azithromycin has been noted to be higher in MSM 3,4,6 . This association has not, however, been found in other countries.…”