title: Exploring the Benefits of Molecular Testing for Gonorrhoea Antibiotic Resistance Surveillance in Remote Settings.
abstract: BACKGROUND
  Surveillance for gonorrhoea antimicrobial resistance (AMR) is compromised by a move away from culture-based testing in favour of more convenient nucleic acid amplification test (NAAT) tests. We assessed the potential benefit of a molecular resistance test in terms of the timeliness of detection of gonorrhoea AMR.
  
  
  RESULTS
  An individual-based mathematical model was developed to describe the transmission of gonorrhoea in a remote Indigenous population in Australia. We estimated the impact of the molecular test on the time delay between first importation and the first confirmation that the prevalence of gonorrhoea AMR (resistance proportion) has breached the WHO-recommended 5% threshold (when a change in antibiotic should occur). In the remote setting evaluated in this study, the model predicts that when culture is the only available means of testing for AMR, the breach will only be detected when the actual prevalence of AMR in the population has already reached 8 - 18%, with an associated delay of ~43 - 69 months between first importation and detection. With the addition of a molecular resistance test, the number of samples for which AMR can be determined increases facilitating earlier detection at a lower resistance proportion. For the best case scenario, where AMR can be determined for all diagnostic samples, the alert would be triggered at least 8 months earlier than using culture alone and the resistance proportion will have only slightly exceeded the 5% notification threshold.
  
  
  CONCLUSIONS
  Molecular tests have the potential to provide more timely warning of the emergence of gonorrhoea AMR. This in turn will facilitate earlier treatment switching and more targeted treatment, which has the potential to reduce the population impact of gonorrhoea AMR.
authors.affiliation: The Kirby Institute, UNSW Australia, Sydney, New South Wales, Australia.
authors.forename: Ben B
authors.initials: BB
authors.lastname: Hui
authors.affiliation: Sexual Health and Blood Borne Virus Unit, Centre for Disease Control, Department of Health, Darwin, Northern Territory, Australia.
authors.forename: Nathan
authors.initials: N
authors.lastname: Ryder
authors.affiliation: Sexual Health and Blood Borne Virus Unit, Centre for Disease Control, Department of Health, Darwin, Northern Territory, Australia.
authors.forename: Jiunn-Yih
authors.initials: JY
authors.lastname: Su
authors.affiliation: South Australian Health and Medical Research Institute, North Terrace, Adelaide, South Australia, Australia.
authors.forename: James
authors.initials: J
authors.lastname: Ward
authors.affiliation: Central Clinical School, Monash University, Melbourne, Victoria, Australia; Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia; School of Population and Global Health, University of Melbourne, Melbourne, Australia.
authors.forename: Marcus Y
authors.initials: MY
authors.lastname: Chen
authors.affiliation: The Kirby Institute, UNSW Australia, Sydney, New South Wales, Australia; Sydney Sexual Health Centre, Sydney Hospital, Sydney, New South Wales, Australia.
authors.forename: Basil
authors.initials: B
authors.lastname: Donovan
authors.affiliation: Central Clinical School, Monash University, Melbourne, Victoria, Australia; Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia; School of Population and Global Health, University of Melbourne, Melbourne, Australia.
authors.forename: Christopher K
authors.initials: CK
authors.lastname: Fairley
authors.affiliation: The Kirby Institute, UNSW Australia, Sydney, New South Wales, Australia.
authors.forename: Rebecca J
authors.initials: RJ
authors.lastname: Guy
authors.affiliation: WHO Collaborating Centre for STD, Microbiology Department, South Eastern Area Laboratory Services, Prince of Wales Hospital, Sydney, New South Wales, Australia.
authors.forename: Monica M
authors.initials: MM
authors.lastname: Lahra
authors.affiliation: The Kirby Institute, UNSW Australia, Sydney, New South Wales, Australia.
authors.forename: Mathew G
authors.initials: MG
authors.lastname: Law
authors.affiliation: Queensland Paediatric Infectious Diseases Laboratory, Queensland Children's Health Services, Queensland, Australia; Queensland Children's Medical Research Institute, University of Queensland, Queensland, Australia.
authors.forename: David M
authors.initials: DM
authors.lastname: Whiley
authors.affiliation: The Kirby Institute, UNSW Australia, Sydney, New South Wales, Australia.
authors.forename: David G
authors.initials: DG
authors.lastname: Regan
mesh_terms: D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D001315:Australia / Q000453:epidemiology; D015373:Bacterial Typing Techniques; D018563:Disease Notification; D062665:Epidemiological Monitoring; D005260:Female; D006069:Gonorrhea / Q000188:drug therapy* / Q000453:epidemiology / Q000208:ethnology* / Q000635:transmission; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D009344:Neisseria gonorrhoeae / Q000187:drug effects* / Q000235:genetics / Q000254:growth & development; D010403:Penicillin Resistance; D010406:Penicillins / Q000494:pharmacology*; D044382:Population Groups; D015995:Prevalence
chemical_list: D000900:Anti-Bacterial Agents; D010406:Penicillins