title: Public health measures to control the spread of antimicrobial resistance in Neisseria gonorrhoeae in men who have sex with men.
abstract: Gonorrhoea is one of the most common sexually transmitted infections. The control of gonorrhoea is extremely challenging because of the repeated development of resistance to the antibiotics used for its treatment. We explored different strategies to control the spread of antimicrobial resistance and prevent increases in gonorrhoea prevalence. We used a mathematical model that describes gonorrhoea transmission among men who have sex with men and distinguishes gonorrhoea strains sensitive or resistant to three antibiotics. We investigated the impact of combination therapy, switching first-line antibiotics according to resistance thresholds, and other control efforts (reduced sexual risk behaviour, increased treatment rate). Combination therapy can delay the spread of resistance better than using the 5% resistance threshold. Increased treatment rates, expected to enhance gonorrhoea control, may reduce gonorrhoea prevalence only in the short term, but could lead to more resistance and higher prevalence in the long term. Re-treatment of resistant cases with alternative antibiotics can substantially delay the spread of resistance. In conclusion, combination therapy and re-treatment of resistant cases with alternative antibiotics could be the most effective strategies to prevent increases in gonorrhoea prevalence due to antimicrobial resistance.
authors.affiliation: Centre for Infectious Disease Control,National Institute of Public Health and Environment,Bilthoven,The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: Xiridou
authors.affiliation: Centre for Infectious Disease Control,National Institute of Public Health and Environment,Bilthoven,The Netherlands.
authors.forename: L C
authors.initials: LC
authors.lastname: Soetens
authors.affiliation: Centre for Infectious Disease Control,National Institute of Public Health and Environment,Bilthoven,The Netherlands.
authors.forename: F D H
authors.initials: FD
authors.lastname: Koedijk
authors.affiliation: Centre for Infectious Disease Control,National Institute of Public Health and Environment,Bilthoven,The Netherlands.
authors.forename: M A B
authors.initials: MA
authors.lastname: VAN DER Sande
authors.affiliation: Centre for Infectious Disease Control,National Institute of Public Health and Environment,Bilthoven,The Netherlands.
authors.forename: J
authors.initials: J
authors.lastname: Wallinga
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D003140:Communicable Disease Control; D024881:Drug Resistance, Bacterial; D057915:Drug Substitution; D004359:Drug Therapy, Combination; D006069:Gonorrhea / Q000188:drug therapy / Q000517:prevention & control* / Q000635:transmission; D018451:Homosexuality, Male; D006801:Humans; D008297:Male; D008962:Models, Theoretical; D009344:Neisseria gonorrhoeae; D011634:Public Health; D012309:Risk-Taking
chemical_list: D000900:Anti-Bacterial Agents
keywords: men who have sex with men