{"id":1188,"date":"2016-07-20T17:25:20","date_gmt":"2016-07-20T16:25:20","guid":{"rendered":"https:\/\/blogs.bmj.com\/sti\/?p=1188"},"modified":"2016-07-18T17:27:01","modified_gmt":"2016-07-18T16:27:01","slug":"is-increasing-gonorrhoea-resistance-in-msm-is-a-result-of-more-treatment-rather-than-greater-sexual-activity","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/sti\/2016\/07\/20\/is-increasing-gonorrhoea-resistance-in-msm-is-a-result-of-more-treatment-rather-than-greater-sexual-activity\/","title":{"rendered":"Is increasing gonorrhoea resistance in MSM is a result of more treatment, rather than greater sexual activity?"},"content":{"rendered":"

Emerging antibiotic resistance to the last-ditch treatment of Neisseria gonorrhoeae compels health policy-makers to balance opposing concerns.\u00a0 On the one hand, successfully combating spread of the infection requires targeted treatment of core-group individuals.\u00a0 On the other,\u00a0a focus on the core-group causes a rebound in core-group incidence, with maximal dissemination of resistance (Chan & McCabe\/STIs<\/a> (C&M); Chan & Fisman\/STIs<\/a>).<\/p>\n

Recent public health orthodoxy has tended to favour the more intensive screening of core-group individuals (Ison & Unemo (STI)<\/a>; Giguere & Alary\/STIs<\/a>; Lewis\/STIs<\/a>).\u00a0 However Fingerhut & Althaus<\/a> (F&A), in a recent modelling study, seek to shift the balance in the opposite direction.\u00a0 They claim their model demonstrates that the wide disparity in the spread of resistance spread\u00a0as between populations of MSM and of HMW (heterosexual men and women) reflects differing levels of treatment<\/em> rather than differences in sexual behaviour (\u2018more sexual partners\u2019).<\/p>\n

So far as concerns the first part of the claim (\u2018gonorrhoea spreads faster with more treatment\u2019), F&A’s findings corroborate those of C&M.\u00a0 However, in coupling this with the claim that gonorrhoea spread is not<\/em> the result of sexual behaviour (\u2018gonorrhoea (does not) spread faster with more sexual partners\u2019) they place the balance of responsibility for spread with the prevailing policy of treatment.\u00a0 This is presumably intended to push policy makers\u00a0in the direction of\u00a0a more conservative attitude to targeting testing and screening.<\/p>\n

But can F&A really justify this\u00a0 change of emphasis by differentiating the respective contributions\u00a0of\u00a0‘more treatment’\u00a0as against ‘greater\u00a0sexual activity’ to the difference in resistance between MSM and MSW popultions\u00a0?\u00a0\u00a0We are wrong, the authors argue,\u00a0to assume that\u00a0‘more\u00a0partners’ amongst the MSM population\u00a0necessarily\u00a0entails more transmissions\u00a0(p. 11) – and their model apparently demonstrates this.\u00a0\u00a0 A common sense response, however, would be to\u00a0object that\u00a0‘more partners’ presumably implies ‘more sex acts with more partners’ – and that, even if ‘more partners’ does not in itself\u00a0entail\u00a0more transmissions, ‘more sex acts with more\u00a0partners’\u00a0might certainly be expected to do so.<\/p>\n

Interestingly,\u00a0Althaus in another paper\u00a0(see Althaus & Alizon<\/a>) – admittedly, in connection with heterosexual groups –\u00a0corroborates\u00a0our common sense expectation by showing that the number of partners displays, if not a proportional, then at least a linear, relation\u00a0 to number of sex acts. So\u00a0can it really be\u00a0the case that\u00a0there is not a greater number of transmissions amongst the MSM population, given the greater number of partners? The authors evidently believe\u00a0not.<\/p>\n

Nevertheless, it would be interesting – as well as pertinent, I suspect,\u00a0to the\u00a0goals of the study – to have a more satisfying\u00a0explanation of why, here, as elsewhere, common sense\u00a0turns out to be wrong.<\/p>\n

 <\/p>\n

 <\/p>\n

 <\/p>\n","protected":false},"excerpt":{"rendered":"

Emerging antibiotic resistance to the last-ditch treatment of Neisseria gonorrhoeae compels health policy-makers to balance opposing concerns.\u00a0 On the one hand, successfully combating spread of the infection requires targeted treatment of core-group individuals.\u00a0 On the other,\u00a0a focus on the core-group causes a rebound in core-group incidence, with maximal dissemination of resistance (Chan & McCabe\/STIs (C&M); […]<\/p>\n

Read More…<\/a><\/p>\n","protected":false},"author":152,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[4353,2043,2103,264,2713,599],"tags":[],"class_list":["post-1188","post","type-post","status-publish","format-standard","hentry","category-antimicrobial-resistance","category-behaviour","category-gonorrhoea","category-health-policy","category-modelling","category-screening"],"yoast_head":"\nIs increasing gonorrhoea resistance in MSM is a result of more treatment, rather than greater sexual activity? - Sexually Transmitted Infections<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/sti\/2016\/07\/20\/is-increasing-gonorrhoea-resistance-in-msm-is-a-result-of-more-treatment-rather-than-greater-sexual-activity\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Is increasing gonorrhoea resistance in MSM is a result of more treatment, rather than greater sexual activity? 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