Abstract
In this study, we assessed if there was a city-level association between sexually transmitted infection (STI) screening intensity in men who have sex with men and antimicrobial sensitivity in Neisseria gonorrhoeae in the United States, 2007 to 2013. We found positive associations between STI screening intensity and increases in minimum inhibitory concentrations for cefixime and azithromycin, but not ceftriaxone.
Highlights
In the United States (USA) the prevalence of antimicrobial resistance in Neisseria gonorrhoeae has typically been higher in men who have sex with men (MSM) than men who have sex with women (MSW) and women[1,2]
A plausible reason for the lack of association between ceftriaxone and minimum inhibitory concentration (MIC) change is that ceftriaxone has been used almost exclusively in combination with azithromycin[3,15] and even on its own may be less susceptible to the develop of resistance than cefixime and azithromycin[16]
These findings are compatible with the theory that screening intensity plays a role in the selection of antimicrobial resistance in N. gonorrhoeae in MSM
Summary
In the United States (USA) the prevalence of antimicrobial resistance in Neisseria gonorrhoeae has typically been higher in men who have sex with men (MSM) than men who have sex with women (MSW) and women[1,2]. Resistance has characteristically emerged in the West Coast and Hawaii and spread eastward[1,2,3]. This patterning of spread has led to the view that a primary driver of resistance is the import of resistant gonococci from eastern Asia and other world regions[3]. In support of this theory, a number of studies have documented travel as a means of import of resistance in the USA4,5. An analysis of data from the Gonococcal Isolate Surveillance Project (GISP) 2002 to 2007, for example, found a pronounced increase in ciprofloxacin-resistance in MSM and a smaller and later increase in MSW; the association with recent travel was negative in MSM and borderline positive in MSW7
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