Allen Hester, Merrick Rachel, Ivanov Zdravko, Pitt Rachel, Mohammed Hamish, Sinka Katy, Hughes Gwenda, Fifer Helen, Cole Michelle Jayne
Blood Safety, Hepatitis, Sexually Transmitted Infections (STI) and HIV Division, UK Health Security Agency, London, UK
Blood Safety, Hepatitis, Sexually Transmitted Infections (STI) and HIV Division, UK Health Security Agency, London, UK.
Sex Transm Infect. 2023 Feb;99(1):1-6. doi: 10.1136/sextrans-2021-055298. Epub 2022 Mar 4.
Quarterly STI screening is recommended for high-risk gay, bisexual and other men who have sex with men (MSM) in the UK, but frequent antibiotic exposure could potentially increase the risk of antimicrobial resistance (AMR) developing in . We investigated whether repeat diagnosis of gonorrhoea in those attending sexual health services (SHS) was associated with reduced antimicrobial susceptibility.
Antimicrobial susceptibility data relating to the most recent gonorrhoea diagnosis for each individual included in the Gonococcal Resistance to Antimicrobials Surveillance Programme (2015-2019) were matched to their historical records in the national GUMCAD STI surveillance data set (2012-2019). The number of gonorrhoea diagnoses in the previous 3 years was calculated for each SHS attendee. Logistic regression was used to examine the associations between the number of diagnoses and reduced susceptibility to ceftriaxone (minimum inhibitory concentration (MIC) >0.03 mg/L), cefixime (MIC >0.06 mg/L) and azithromycin (MIC >0.25 mg/L) at the time of the latest diagnosis.
Of 6161 individuals included in the analysis, 3913 (63.5%) were MSM, 1220 (19.8%) were heterosexual men and 814 (13.2%) were women. Among MSM, 2476 (63.3%) had 1 past gonorrhoea diagnosis, 1295 (33.1%) had 2-4, 140 (3.6%) 5-9, and 2 (0.1%) ≥10. Most women and heterosexual men (91.7%) had one past gonorrhoea diagnosis; none had more than four. Reduced ceftriaxone and cefixime susceptibility was more common among MSM with two to four gonorrhoea diagnoses (3.8% and 5.8%, respectively) compared with those with one (2.2% and 3.9%, respectively). After adjusting for potential confounding, this association remained (adjusted OR: 1.59, 95% CI 1.07 to 2.37, p=0.02; adjusted OR: 1.54, 95% CI 1.11 to 2.14, p=0.01). No evidence was found for any other associations.
Among MSM, repeat diagnosis of gonorrhoea may be associated with reduced ceftriaxone and cefixime susceptibility. As these are last-line therapies for gonorrhoea, further research is needed to assess the impact of intensive STI screening on AMR.
在英国，建议对高危男同性恋者、双性恋者及其他与男性发生性行为的男性（男男性行为者）每季度进行性传播感染（STI）筛查，但频繁接触抗生素可能会增加产生抗菌药物耐药性（AMR）的风险。我们调查了在性健康服务机构（SHS）就诊的患者中，淋病的反复诊断是否与抗菌药物敏感性降低有关。
将淋病抗菌药物耐药性监测项目（2015 - 2019年）中纳入的每个个体的最新淋病诊断的抗菌药物敏感性数据与其在国家GUMCAD性传播感染监测数据集（2012 - 2019年）中的历史记录进行匹配。计算每个SHS就诊者在过去3年中的淋病诊断次数。使用逻辑回归分析来检验诊断次数与最新诊断时对头孢曲松（最低抑菌浓度（MIC）>0.03mg/L）、头孢克肟（MIC >0.06mg/L）和阿奇霉素（MIC >0.25mg/L）敏感性降低之间的关联。
纳入分析的6161名个体中，3913名（63.5%）为男男性行为者，1220名（19.8%）为异性恋男性，814名（13.2%）为女性。在男男性行为者中，2476名（63.3%）曾有过1次淋病诊断，1295名（33.1%）有过2 - 4次，140名（3.6%）有过5 - 9次，2名（0.1%）有过≥10次。大多数女性和异性恋男性（91.7%）曾有过1次淋病诊断；无人超过4次。与仅有1次淋病诊断的男男性行为者（分别为2.2%和3.9%）相比，有2 - 4次淋病诊断的男男性行为者中头孢曲松和头孢克肟敏感性降低更为常见（分别为3.8%和5.8%）。在对潜在混杂因素进行调整后，这种关联仍然存在（调整后的比值比：1.59，95%置信区间1.07至2.37，p = 0.02；调整后的比值比：1.54，95%置信区间1.11至2.14，p = 0.01）。未发现其他关联的证据。
在男男性行为者中，淋病的反复诊断可能与头孢曲松和头孢克肟敏感性降低有关。由于这些是淋病的一线治疗药物，需要进一步研究以评估强化性传播感染筛查对抗菌药物耐药性的影响。
