Antibiotic treatment speeds up spread of gonorrhea resistance

Screening and treatment of infected patients, rather than frequent change of sexual partners, found to be the major driver of antibiotic resistance spread in gonorrhea.

Neisseria gonorrhoeae is a sexually transmitted bacterium that has developed broad resistance against antibiotics. Current public health efforts aim to reduce the overall burden of N. gonorrhoeae infection by expanded screening and treatment of sexually active individuals. Concerned about the uncertain consequences of this strategy for antibiotic resistance, researchers from the ISPM, together with colleagues from ETH Zurich, used mathematical modelling to understand what drives the spread of resistance.

In a study published in PLOS Pathogens, the researchers analyzed data from surveillance programs and found that resistant strains spread much faster in men who have sex with men (MSM) than in heterosexual populations. On average, MSM do have more sexual partners than heterosexual men and women. However, the intuitive argument that a faster spread of an infection, due to a higher number of sexual partners, will result in a faster spread of resistance did not hold. Rather than the higher number of partners, it was the higher level of antibiotic treatment for N. gonorrhoeae infections among MSM (presumably because they more frequently develop symptoms or seek out screening for STIs) that was responsible for the faster spread of resistance.

This has obvious implications. As the researchers discuss, "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."

Read the publication here