National Institute for Health Research Health Protection Research Unit in Blood Borne and Sexually Transmitted Infections at University College London in partnership with Public Health England and in collaboration with the London School of Hygiene and Tropical Medicine, Mortimer Market Centre, Third Floor, Capper Street, London WC1E 6JB, UK; Centre for Molecular Epidemiology and Translational Research, Institute for Global Health, University College London, Mortimer Market Centre, Capper Street, London WC1E 6JB, UK.
HIV/STI Department, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK.
J Infect. 2018 Jun;76(6):507-514. doi: 10.1016/j.jinf.2018.02.011. Epub 2018 Apr 24.
Neisseria gonorrhoeae (NG) is a significant global public health concern due to rising diagnoses rates and antimicrobial resistance. Molecular combined with epidemiological data have been used to understand the distribution and spread of NG, as well as relationships between cases in sexual networks, but the public health value gained from these studies is unclear. We conducted a systematic review to examine how molecular epidemiological studies have informed understanding of sexual networks and NG transmission, and subsequent public health interventions.
Five research databases were systematically searched up to 31st March 2017 for studies that used sequence-based DNA typing methods, including whole genome sequencing, and linked molecular data to patient-level epidemiological data. Data were extracted and summarised to identify common themes.
Of the 49 studies included, 82% used NG Multi-antigen Sequence Typing. Gender and sexual orientation were commonly used to characterise sexual networks that were inferred using molecular clusters; clusters predominantly of one patient group often contained a small number of isolates from other patient groups. Suggested public health applications included using these data to target interventions at specific populations, confirm outbreaks, and inform partner management, but these were mainly untested.
Combining molecular and epidemiological data has provided insight into sexual mixing patterns, and dissemination of NG, but few studies have applied these findings to design or evaluate public health interventions. Future studies should focus on the application of molecular epidemiology in public health practice to provide evidence for how to prevent and control NG.
淋病奈瑟菌（NG）是一个严重的全球公共卫生问题，因为其诊断率上升和抗微生物药物耐药性。分子流行病学数据结合已被用于了解 NG 的分布和传播，以及性网络中病例之间的关系，但这些研究带来的公共卫生价值尚不清楚。我们进行了一项系统评价，以检验分子流行病学研究如何有助于了解性网络和 NG 传播，以及随后的公共卫生干预措施。
截至 2017 年 3 月 31 日，我们系统地检索了五个研究数据库，以查找使用基于序列的 DNA 分型方法（包括全基因组测序）并将分子数据与患者水平流行病学数据相关联的研究。提取和总结数据以确定共同的主题。
在纳入的 49 项研究中，82%使用了 NG 多抗原序列分型。性别和性取向常用于描述通过分子聚类推断的性网络；主要由一个患者组组成的聚类通常包含来自其他患者组的少数分离株。建议的公共卫生应用包括将这些数据用于针对特定人群的干预措施、确认暴发以及为伙伴管理提供信息，但这些应用主要未经测试。
将分子和流行病学数据相结合，深入了解了性混合模式和 NG 的传播，但很少有研究将这些发现应用于设计或评估公共卫生干预措施。未来的研究应侧重于分子流行病学在公共卫生实践中的应用，为如何预防和控制 NG 提供证据。
