Intensively screening people at low risk for N. gonorrhoea has little impact on transmission

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The authors report no relevant financial disclosures.

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Key takeaways:

• High-risk men who have sex with men “drive the Neisseria gonorrhoea epidemic.”
• STI screening in the low-risk group had very little effect in lowering N. gonorrhoea case numbers.

A network-based model demonstrated that men who have sex with men drive the Neisseria gonorrhoeae epidemic and that intensive screening in the low-risk population had little impact on lowering transmission rates.

“Neisseria gonorrhoeae is a sexually transmitted bacterium that causes the disease gonorrhea. The number of people reporting a N. gonorrhoea infection is increasing steadily over the last years in many European countries, the United States, Australia and elsewhere,” Achilles Tsoumanis, MSc, biostatistician at Institute of Tropical Medicine in Antwerp, Belgium, told Healio.

Sexually transmitted infection screening among people at low risk for Neisseria gonorrhoeae had very little effect in decreasing infection incidence. Image: Adobe Stock.

“Men who have sex with men (MSM) is one of the communities that have reported the highest incidences of N. gonorrhoea (around 50% of the cases). Although N. gonorrhoea is curable using antibiotics, N. gonorrhoea has shown antimicrobial resistance to all classes of antibiotics [to which] it has been exposed, raising concerns that it could become incurable in the near future,” he said.

According to Tsoumanis, sexually transmitted infection screening is one strategy used to control the increasing numbers of N. gonorrhoea. However, a counterargument raised by many researchers, according to Tsoumanis, is that individuals at high risk are part of a “dense sexual network” with multiple partners, with many of them being concurrent. Thus, screening those individuals and treating them with antibiotics will have only a short-term effect in controlling the N. gonorrhoea incidence.

“At the same time, without any behavioral change, those individuals will resume their regular activities, will likely be reinfected and re-treated, thus overexposing them to antibiotics and, in a way, causing more pressure on N. gonorrhoea to develop antimicrobial resistance ,” Tsoumanus said.

Because there are no randomized clinical trials evaluating the effect of screening, Tsoumanis and colleagues developed a simulation model showing daily transmission of N. gonorrhoea among three anatomical sites in a population of 10,000 MSM.

Members of the model population were grouped as low or high risk over 10 years to assess how screening intensity affects N. gonorrhoea prevalence and the probability of antimicrobial resistance in a population of MSM in Belgium.

The model demonstrated that increasing screening intensity among low-risk MSM had little effect on N. gonorrhoea prevalence. Tsoumanis said that even though screening decreased the prevalence of the disease overall, screening in the low-risk group appeared to have very little effect in decreasing N. gonorrhoea prevalence “no matter how intensive.”

Additionally, high-risk MSM were at higher risk for azithromycin-resistant N. gonorrhoea in all screening intensity and treatment efficacy scenarios compared with low-risk MSM. Although the period prevalence over 3,600 days for azithromycin resistance was higher in the high-risk group vs. the low-risk group for all screening intensity scenarios, it remained low for all scenarios at less than 0.76% of all N. gonorrhoea infections.

Overall, however, high-risk MSM were at higher risk for azithromycin-resistant N. gonorrhoea in all screening intensity and treatment efficacy scenarios, according to the study.

“As this is a modeling study, it cannot be interpreted as clinical evidence rather than indications,” Tsoumanis said. “Clinical trials would be the only reliable way to evaluate the effect of screening in gonorrhea prevalence and the risk for emergence of antimicrobial resistance.”

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