Abstract
BackgroundAntibiotic resistance is threatening to make gonorrhoea untreatable. Point-of-care (POC) tests that detect resistance promise individually tailored treatment, but might lead to more treatment and higher levels of resistance. We investigate the impact of POC tests on antibiotic-resistant gonorrhoea.MethodsWe used data about the prevalence and incidence of gonorrhoea in men who have sex with men (MSM) and heterosexual men and women (HMW) to calibrate a mathematical gonorrhoea transmission model. With this model, we simulated four clinical pathways for the diagnosis and treatment of gonorrhoea: POC test with (POC+R) and without (POC−R) resistance detection, culture and nucleic acid amplification tests (NAATs). We calculated the proportion of resistant infections and cases averted after 5 years, and compared how fast resistant infections spread in the populations.ResultsThe proportion of resistant infections after 30 years is lowest for POC+R (median MSM: 0.18%, HMW: 0.12%), and increases for culture (MSM: 1.19%, HMW: 0.13%), NAAT (MSM: 100%, HMW: 99.27%), and POC−R (MSM: 100%, HMW: 99.73%). Per 100 000 persons, NAAT leads to 36 366 (median MSM) and 1228 (median HMW) observed cases after 5 years. Compared with NAAT, POC+R averts more cases after 5 years (median MSM: 3353, HMW: 118). POC tests that detect resistance with intermediate sensitivity slow down resistance spread more than NAAT. POC tests with very high sensitivity for the detection of resistance are needed to slow down resistance spread more than by using culture.ConclusionsPOC with high sensitivity to detect antibiotic resistance can keep gonorrhoea treatable longer than culture or NAAT. POC tests without reliable resistance detection should not be introduced because they can accelerate the spread of antibiotic-resistant gonorrhoea.
Highlights
Antibiotic resistance is threatening to make gonorrhoea untreatable
We investigated the potential impact of POC tests on resistance and on the number of gonorrhoea cases for a population at high risk of infection [20], men who have sex with men (MSM), and a population at lower risk of infection, heterosexual men and women (HMW)
We found that POC + R can slow resistance spread and reduce the number of gonorrhoea cases compared with culture or Nucleic acid amplification test (NAAT)
Summary
Point-of-care (POC) tests that detect resistance promise individually tailored treatment, but might lead to more treatment and higher levels of resistance. We investigate the impact of POC tests on antibiotic-resistant gonorrhoea. Antibiotic resistance is a major challenge for the management of gonorrhoea globally: extended-spectrum cephalosporins are the last antibiotic class remaining for empirical treatment of gonorrhoea [1, 2], and 42 countries have already reported Neisseria gonorrhoeae strains with decreased susceptibility against them [2]. The first strain with high-level resistance to the recommended combination therapy with ceftriaxone and azithromycin was Conventional diagnostic tests for gonorrhoea, such as nucleic acid amplification tests (NAATs) and culture, are not sufficient to control antibiotic resistance. Available NAATs, the most commonly used diagnostic gonorrhoea tests in high-income countries, cannot detect antibiotic resistance [5, 6]. Culture and susceptibility testing need several days to deliver results. Loss to follow-up and the further spread of resistant infections can result
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