Volume 24, Number 7—July 2018
Effects of Sexual Network Connectivity and Antimicrobial Drug Use on Antimicrobial Resistance in Neisseria gonorrhoeae
|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.|
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