Department of Microbiology, Public Health England Collaborative Centre, Royal Sussex County Hospital, Brighton, UK.
Department of Microbiology and Infection, Royal Sussex County Hospital, Brighton, UK.
Sex Transm Infect. 2018 Mar;94(2):138-143. doi: 10.1136/sextrans-2017-053198. Epub 2017 Oct 11.
Prevention and control of gonorrhoea depends on understanding the nature of sexual networks and risk factors for infection. We aimed to use high-resolution typing (whole genome sequencing (WGS)) of isolates plus patient questionnaire data to gain insights into transmission patterns in a high prevalence setting.
During a 9-month period (July 2014-March 2015), patients diagnosed with gonorrhoea attending sexual health service in Brighton, UK, were invited to provide anonymised detailed information by questionnaire about risk factors for infection. Questionnaire data plus WGS data from cultured isolates were analysed to yield information about sexual networks and risk factors for infection.
104/149 individuals who consented to participate in the study were culture positive. 97/104 (93%) were male. 80 self-reported to be men who have sex with men (MSM). 35/104 (34%) of patients were HIV positive. 51/104 (49%) individuals reported using geosocial networking applications to facilitate contact. Sex under the influence of drugs was reported by 16/34 (46%) of HIV-positive MSM, 17/41 (41%) of HIV-negative MSM and 5/15 (31%) of heterosexuals. WGS data were available for 100 isolates from 83 patients. 55 isolates (66%) belonged to genetically related subtypes involving one or more patients, who could be plausibly linked through recent direct or indirect transmission. Four transmission clusters containing 3-12 individuals were composed of MSM of mixed HIV serostatus.
We show that data obtained from WGS of and enhanced epidemiological data obtained from patient questionnaires are mutually supportive and reveal insights into sexual networks. Our findings suggest that serosorting may have declined as a practice and indicate the importance of designing public health interventions that target infection risks associated with recreational drug use and contact made using geosocial networking applications.
淋病的预防和控制取决于对性网络性质和感染风险因素的了解。我们旨在通过对分离株进行高分辨率分型（全基因组测序（WGS））和患者问卷调查数据，深入了解高流行地区的传播模式。
在 9 个月的时间内（2014 年 7 月至 2015 年 3 月），英国布莱顿性健康服务机构就诊并被诊断患有淋病的患者被邀请通过问卷提供有关感染风险因素的匿名详细信息。对问卷数据和培养分离株的 WGS 数据进行分析，以获取有关性网络和感染风险因素的信息。
149 名同意参与研究的患者中，有 104 名培养呈阳性。97/104（93%）为男性。80 人自述为男男性接触者（MSM）。35/104（34%）的患者 HIV 阳性。104/104（49%）的个体报告使用地理社交网络应用程序来促进联系。16/34（46%）的 HIV 阳性 MSM、17/41（41%）的 HIV 阴性 MSM 和 5/15（31%）的异性恋者报告称在吸毒影响下发生性行为。来自 83 名患者的 100 株分离株可获得 WGS 数据。55 株（66%）属于涉及一个或多个患者的遗传相关亚型，这些患者可能通过最近的直接或间接传播合理地联系在一起。包含 3-12 名个体的四个传播群由混合 HIV 血清阳性的 MSM 组成。
我们表明，从 WGS 分离株获得的数据和从患者问卷调查获得的增强流行病学数据是相互支持的，并揭示了对性网络的深入了解。我们的发现表明，血清分型可能已经不再是一种做法，并表明设计针对与娱乐性药物使用和使用地理社交网络应用程序建立联系相关的感染风险的公共卫生干预措施的重要性。
