Abstract
Whole genome sequencing (WGS) has been used to investigate transmission of Neisseria gonorrhoeae, but to date, most studies have not combined genomic data with detailed information on sexual behaviour to define the extent of transmission across population risk groups (bridging). Here, through combined epidemiological and genomic analysis of 2,186N. gonorrhoeae isolates from Australia, we show widespread transmission of N. gonorrhoeae within and between population groups. We describe distinct transmission clusters associated with men who have sex with men (MSM) and heterosexuals, and men who have sex with men and women (MSMW) are identified as a possible bridging population between these groups. Further, the study identifies transmission of N. gonorrhoeae between HIV-positive and HIV-negative individuals receiving pre-exposure prophylaxis (PrEP). Our data highlight several groups that can be targeted for interventions aimed at improving gonorrhoea control, including returning travellers, sex workers, and PrEP users.
Highlights
Whole genome sequencing (WGS) has been used to investigate transmission of Neisseria gonorrhoeae, but to date, most studies have not combined genomic data with detailed information on sexual behaviour to define the extent of transmission across population risk groups
To further contextualise our data, we undertook combined analysis of the 388 MLST 9363 isolates in our study, and publicly available MLST 9363 isolates (151 isolates) from a recent US Gonococcal Surveillance Isolate Project (GISP) study conducted between 2014 and 201622. 381 isolates (292 from Australia and 89 from the United States) contained an identical mosaic mtrD, and an identical mosaic mtrR gene (Supplementary Data 2 and Supplementary Fig. 10). To our knowledge this is the first study to combine WGS of N. gonorrhoeae with comprehensive individual-level sexual behavioural data, providing a detailed picture of the transmission of distinct gonococcal strains between men who have sex with men (MSM), heterosexual males and females, HIV-positive MSM, HIV-negative pre-exposure prophylaxis (PrEP) users, and sex workers. These data provide insights into transmission between distinct population risk groups, and applied in real-time could allow interventions aimed at controlling gonorrhoea to be provided at a time when current control measures are failing
MSMW with gonorrhoea were scattered within MSM and heterosexual networks suggesting a possible role in bridging transmission between men who had sex with men only (MSMO) and females, given our sampling frame, it is not possible to say whether these were responsible for the commencement of transmission clusters
Summary
Whole genome sequencing (WGS) has been used to investigate transmission of Neisseria gonorrhoeae, but to date, most studies have not combined genomic data with detailed information on sexual behaviour to define the extent of transmission across population risk groups (bridging). Prevention of gonorrhoea has relied on public health measures, such as condom use, educational messaging, and screening to detect asymptomatic carriage of N. gonorrhoeae Despite these measures, the incidence of gonorrhoea is increasing, predominantly in men who have sex with men (MSM), and more recently in heterosexual populations[4,8]. Whole genome sequencing (WGS) has been used to provide insights into the local and global emergence and transmission of gonorrhoea, including AMR lineages[15,16,17,18,19] To date, these studies have not focused on assessing transmission across population risk groups (bridging), utilising individual-level sexual behavioural data. Through detailed genomic analysis of all N. gonorrhoeae isolates detected in the state of Victoria, Australia in 2017, we reveal extensive bridging of lineages across groups with differing epidemiological risk factors, including sexual behaviour, overseas travel, HIV status and sex work. Our findings represent the most comprehensive genomic analysis of N. gonorrhoeae from the Southern Hemisphere to date and highlight the need for new and enhanced public health interventions to control this 21st century epidemic of gonorrhoea
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