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Volume 24, Number 7—July 2018
Perspective

Effects of Sexual Network Connectivity and Antimicrobial Drug Use on Antimicrobial Resistance in Neisseria gonorrhoeae

Chris R. KenyonComments to Author  and Ilan S. Schwartz
Author affiliations: Instituut voor Tropische Geneeskunde, Antwerp, Belgium (C.R. Kenyon); University of Cape Town, Cape Town, South Africa (C.R. Kenyon); University of Alberta, Edmonton, Alberta, Canada (I.S. Schwartz)

Main Article

Table 2

Four mechanisms whereby antimicrobial usage might select for antimicrobial resistance in Neisseria gonorrhoeae in a population

Mechanism Description
Emergence of resistance during treatment
 A large proportion of N. gonorrhoeae infections, particularly in MSM, are asymptomatic colonization of the pharynx, where the penetration of many antimicrobials is relatively poor. Because of this or other reasons for suboptimal therapy, a subpopulation of antimicrobial-resistant N. gonorrhoeae may emerge from treatment and may subsequently be transmitted to others.
Reduced transmission of susceptible strains
 Treating patients with antimicrobial-sensitive N. gonorrhoeae reduces the probability of transmission to others, which in turn increases the probability that others will become infected with resistant N. gonorrhoeae strains.
Increased susceptibility to colonization
 Eradicating a susceptible N. gonorrhoeae strain with treatment may enable infection by a new, resistant N. gonorrhoeae strain previously excluded through bacterial competition. This is possible mainly in high-transmission settings.
Increased density of resistant bacteria following treatment If a person is infected with an antimicrobial-resistant N. gonorrhoeae strain, treatment may eradicate susceptible competing commensal microbes. Relieved of competition, the resistant N. gonorrhoeae strain could expand in the vacated niche.

*Based on Lipsitch et al. (18).

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