Abstract
Background: It is unclear why antimicrobial resistance in Neisseriagonorrhoeae in the United Kingdom (UK) and the United States has tended to first appear in men who have sex with men (MSM). We hypothesize that increased exposure to antimicrobials from intensive STI screening programmes plays a role. Methods: We assess if there is a difference in the distribution of azithromycin, cefixime and ceftriaxone minimum inhibitory concentrations (MICs) between MSM and women in the United Kingdom (UK) where 70% of MSM report STI screening in the past year vs. Belgium where 9% report STI screening in the past year. Our hypothesis is that MICs of the MSM should be higher than those of the women in the UK but not Belgium. Data for the MICs were taken from the Gonococcal Resistance to Antimicrobials Surveillance Programme (GRASP) in the UK in 2010/2011 and 2014 and a similar national surveillance programme in Belgium in 2013/2014 (the first most complete available data). We used the Mann-Whitneytest to compare the MIC distributions between MSM and women within each country Results: In the UK the MICs for all three antimicrobials were significantly higher in MSM than women at both time points (P all <0.0005). In Belgium only the MIC distribution for azithromycin was higher in MSM (P<0.0005). Conclusion: The findings for cefixime and ceftriaxone, but not azithromycin are compatible with our hypothesis that screening-intensity could contribute to the emergence of AMR. Numerous other interpretations of our results are discussed.
Highlights
A striking feature of the patterning of antimicrobial resistance (AMR) is how it has repeatedly emerged in core-groups, either sex workers or men who have sex with men (MSM) with high rates of partner change[1]
If intensive screening in MSM plays a role in generating AMR in MSM in the intensive-screening country we would expect to find a shift in distribution towards higher minimum inhibitory concentrations (MICs) in MSM compared to women for the antimicrobials used as treatment in the screening programme
The distribution of the azithromycin MICs was significantly higher in MSM compared to women (Median MIC 0.25, [IQR 0.25-0.50] vs. 0.25 [0.125-0.25]; P
Summary
A striking feature of the patterning of antimicrobial resistance (AMR) is how it has repeatedly emerged in core-groups, either sex workers or men who have sex with men (MSM) with high rates of partner change[1]. In the USA, UK and the Netherlands, the prevalence of AMR to at least one of ciprofloxacin/cefixime/cefotaxime/azithromycin has been noted to be higher in MSM3,4,6 This association has not, been found in other countries. An analysis of gonococcal AMR in the 24 countries participating in European Gonococcal Antimicrobial Surveillance Programme (Euro-GASP) in 2015, for example, found that cefixime and ciprofloxacin resistance rates were not higher in MSM compared to heterosexual men[7]. Azithromycin (AZM) resistance prevalence was higher in men (both MSM and heterosexuals) than women It is unclear why antimicrobial resistance in Neisseria gonorrhoeae in the United Kingdom (UK) and the United States has tended to first appear in men who have sex with men (MSM).
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