Adaptive guidelines for the treatment of gonorrhea to increase the effective life span of antibiotics among men who have sex with men in the United States: A mathematical modeling study

Autoři: Reza Yaesoubi aff001;  Ted Cohen aff002;  Katherine Hsu aff003;  Thomas L. Gift aff004;  Harrell Chesson aff004;  Joshua A. Salomon aff005;  Yonatan H. Grad aff006
Působiště autorů: Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut, United States of America aff001;  Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, United States of America aff002;  Massachusetts Department of Public Health, Boston, Massachusetts, United States of America aff003;  Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia aff004;  Center for Primary Care & Outcomes Research, School of Medicine, Stanford University, Stanford, California, United States of America aff005;  Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America aff006
Vyšlo v časopise: Adaptive guidelines for the treatment of gonorrhea to increase the effective life span of antibiotics among men who have sex with men in the United States: A mathematical modeling study. PLoS Med 17(4): e32767. doi:10.1371/journal.pmed.1003077
Kategorie: Research Article
doi: 10.1371/journal.pmed.1003077



The rise of gonococcal antimicrobial resistance highlights the need for strategies that extend the clinically useful life span of antibiotics. Because there is limited evidence to support the current practice of switching empiric first-line antibiotic when resistance exceeds 5% in the population, our objective was to compare the impact of alternative strategies on the effective life spans of antibiotics and the overall burden of gonorrhea.

Methods and findings

We developed and calibrated a mathematical model of gonorrhea transmission among men who have sex with men (MSM) in the United States. We calibrated the model to the estimated prevalence of gonorrhea, the rate of gonorrhea cases, and the proportion of cases presenting symptoms among MSM in the US. We used this model to project the effective life span of antibiotics and the number of gonorrhea cases expected under current and alternative surveillance strategies over a 50-year simulation period. We demonstrate that compared to the current practice, a strategy that uses quarterly (as opposed to yearly) surveillance estimates and incorporates both the estimated prevalence of resistance and the trend in the prevalence of resistance to determine treatment guidelines could extend the effective life span of antibiotics by 0.83 years. This is equivalent to successfully treating an additional 80.1 (95% uncertainty interval: [47.7, 111.9]) gonorrhea cases per 100,000 MSM population each year with the first-line antibiotics without worsening the burden of gonorrhea. If the annual number of isolates tested for drug susceptibility is doubled, this strategy could increase the effective life span of antibiotics by 0.94 years, which is equivalent to successfully treating an additional 91.1 (54.3, 127.3) gonorrhea cases per 100,000 MSM population each year without increasing the incidence of gonorrhea. Study limitations include that our conclusions might not be generalizable to other settings because our model describes the transmission of gonorrhea among the US MSM population, and, to better capture uncertainty in the characteristics of current and future antibiotics, we chose to model hypothetical drugs with characteristics similar to the antibiotics commonly used in gonorrhea treatment.


Our results suggest that use of data from surveillance programs could be expanded to prolong the clinical effectiveness of antibiotics without increasing the burden of the disease. This highlights the importance of maintaining effective surveillance systems and the engagement of policy makers to turn surveillance findings into timely and effective decisions.

Klíčová slova:

Antibiotic resistance – Antibiotics – Antimicrobial resistance – Drug information – Drug therapy – Gonorrhea – Men who have sex with men – Treatment guidelines


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