Impact of screening on the prevalence and incidence of Mycoplasma genitalium and its macrolide resistance in men who have sex with men living in Australia: A mathematical model
Background: Mycoplasma genitalium (MG) causes a sexually transmitted infection (STI) with a rising rate of antimicrobial resistance. Currently, guidelines do not recommend screening asymptomatic men who have sex with men (MSM). We developed a mathematical model of MG transmission to examine the impa...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2021-03-01
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| Series: | EClinicalMedicine |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2589537021000596 |
| _version_ | 1818416818269716480 |
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| author | Jason J. Ong Luanqi Ruan Aaron G. Lim Catriona S. Bradshaw David Taylor-Robinson Magnus Unemo Patrick J. Horner Peter Vickerman Lei Zhang |
| author_facet | Jason J. Ong Luanqi Ruan Aaron G. Lim Catriona S. Bradshaw David Taylor-Robinson Magnus Unemo Patrick J. Horner Peter Vickerman Lei Zhang |
| author_sort | Jason J. Ong |
| collection | DOAJ |
| description | Background: Mycoplasma genitalium (MG) causes a sexually transmitted infection (STI) with a rising rate of antimicrobial resistance. Currently, guidelines do not recommend screening asymptomatic men who have sex with men (MSM). We developed a mathematical model of MG transmission to examine the impact of various screening strategies on the incidence and prevalence of MG among MSM attending a sexual health clinic. Methods: A compartmental mathematical model of MG transmission among MSM was constructed and calibrated using data from the Melbourne Sexual Health center, where resistance-guided therapy provides high treatment effectiveness (92–95%). The model stratified men by symptom status, sexual risk behaviours and whether or not they had MG with macrolide resistance. We simulated the impact on endemic steady-state MG prevalence and incidence of the following screening scenarios, namely screening: 1) no MSM; 2) only symptomatic MSM (the current recommendation); 3) all symptomatic and high-risk asymptomatic MSM; and 4) all MSM. Our base case analysis assumed a treatment effectiveness of 92–95% using resistance-guided therapy. We also examined the impact of treatment effectiveness (i.e. the proportion of detected MG that were cured) and screening coverage (i.e. testing rate) on MG prevalence. Findings: The model predicts that the overall endemic MG prevalence is 9.1% (95% CI: 7.9–10.0) in the current situation where screening is only offered to symptomatic MSM (base-case). This would increase to 11·4% (95% confidence intervals (CI): 10.2–13.7) if no MSM are offered screening, but would decrease to 7.3% (95% CI: 5.7–8.4) if all symptomatic and high-risk asymptomatic MSM were offered screening and 6.4% (95% CI: 4.7–7·7) if all MSM were offered screening. Increasing coverage of MSM screening strategies shows a similar effect on decreasing endemic MG incidence. When evaluating the simultaneous impact of treatment effectiveness and screening coverage, we found that offering screening to more MSM may reduce the overall prevalence but leads to a higher proportion of macrolide-resistant MG, particularly when using treatment regimens with lower effectiveness. Interpretation: Based on the available treatment options, offering screening for MG to other MSM (beyond the currently recommended group of symptomatic MSM) could slightly reduce the prevalence and incidence of MG. However, further increasing screening coverage must be weighed against the impact of lower treatment effectiveness (i.e. when not using resistance-guided therapy), increasing the selection of macrolide resistance, and other negative consequences related to AMR and management (e.g. unnecessary psychological morbidity from infections that do not need treatment). |
| first_indexed | 2024-12-14T11:56:56Z |
| format | Article |
| id | doaj.art-0c05f8388eef4fea916701a5e0efbbf2 |
| institution | Directory Open Access Journal |
| issn | 2589-5370 |
| language | English |
| last_indexed | 2024-12-14T11:56:56Z |
| publishDate | 2021-03-01 |
| publisher | Elsevier |
| record_format | Article |
| series | EClinicalMedicine |
| spelling | doaj.art-0c05f8388eef4fea916701a5e0efbbf22022-12-21T23:02:05ZengElsevierEClinicalMedicine2589-53702021-03-0133100779Impact of screening on the prevalence and incidence of Mycoplasma genitalium and its macrolide resistance in men who have sex with men living in Australia: A mathematical modelJason J. Ong0Luanqi Ruan1Aaron G. Lim2Catriona S. Bradshaw3David Taylor-Robinson4Magnus Unemo5Patrick J. Horner6Peter Vickerman7Lei Zhang8Central Clinical School, Monash University, Victoria, Melbourne, Australia; Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom; China-Australia Joint Research Center for Infectious Diseases, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, 710061, China; Corresponding authors.China-Australia Joint Research Center for Infectious Diseases, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, 710061, China; Research Base of Key Laboratory of Surveillance and Early Warning on Infectious Disease, Shanghai Pudong New Area Center for Disease Control and Prevention, Shanghai, ChinaPopulation Health Sciences, Bristol Medical School, University of Bristol, Bristol, United KingdomCentral Clinical School, Monash University, Victoria, Melbourne, AustraliaFaculty of Medicine, Imperial College London, London, United KingdomWHO Collaborating Centre for Gonorrhoea and other STIs, Örebro University, Örebro, SwedenPopulation Health Sciences, Bristol Medical School, University of Bristol, Bristol, United KingdomPopulation Health Sciences, Bristol Medical School, University of Bristol, Bristol, United KingdomCentral Clinical School, Monash University, Victoria, Melbourne, Australia; China-Australia Joint Research Center for Infectious Diseases, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, 710061, China; Artificial Intelligence and Modelling in Epidemiology Program, Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia; Corresponding authors.Background: Mycoplasma genitalium (MG) causes a sexually transmitted infection (STI) with a rising rate of antimicrobial resistance. Currently, guidelines do not recommend screening asymptomatic men who have sex with men (MSM). We developed a mathematical model of MG transmission to examine the impact of various screening strategies on the incidence and prevalence of MG among MSM attending a sexual health clinic. Methods: A compartmental mathematical model of MG transmission among MSM was constructed and calibrated using data from the Melbourne Sexual Health center, where resistance-guided therapy provides high treatment effectiveness (92–95%). The model stratified men by symptom status, sexual risk behaviours and whether or not they had MG with macrolide resistance. We simulated the impact on endemic steady-state MG prevalence and incidence of the following screening scenarios, namely screening: 1) no MSM; 2) only symptomatic MSM (the current recommendation); 3) all symptomatic and high-risk asymptomatic MSM; and 4) all MSM. Our base case analysis assumed a treatment effectiveness of 92–95% using resistance-guided therapy. We also examined the impact of treatment effectiveness (i.e. the proportion of detected MG that were cured) and screening coverage (i.e. testing rate) on MG prevalence. Findings: The model predicts that the overall endemic MG prevalence is 9.1% (95% CI: 7.9–10.0) in the current situation where screening is only offered to symptomatic MSM (base-case). This would increase to 11·4% (95% confidence intervals (CI): 10.2–13.7) if no MSM are offered screening, but would decrease to 7.3% (95% CI: 5.7–8.4) if all symptomatic and high-risk asymptomatic MSM were offered screening and 6.4% (95% CI: 4.7–7·7) if all MSM were offered screening. Increasing coverage of MSM screening strategies shows a similar effect on decreasing endemic MG incidence. When evaluating the simultaneous impact of treatment effectiveness and screening coverage, we found that offering screening to more MSM may reduce the overall prevalence but leads to a higher proportion of macrolide-resistant MG, particularly when using treatment regimens with lower effectiveness. Interpretation: Based on the available treatment options, offering screening for MG to other MSM (beyond the currently recommended group of symptomatic MSM) could slightly reduce the prevalence and incidence of MG. However, further increasing screening coverage must be weighed against the impact of lower treatment effectiveness (i.e. when not using resistance-guided therapy), increasing the selection of macrolide resistance, and other negative consequences related to AMR and management (e.g. unnecessary psychological morbidity from infections that do not need treatment).http://www.sciencedirect.com/science/article/pii/S2589537021000596 |
| spellingShingle | Jason J. Ong Luanqi Ruan Aaron G. Lim Catriona S. Bradshaw David Taylor-Robinson Magnus Unemo Patrick J. Horner Peter Vickerman Lei Zhang Impact of screening on the prevalence and incidence of Mycoplasma genitalium and its macrolide resistance in men who have sex with men living in Australia: A mathematical model EClinicalMedicine |
| title | Impact of screening on the prevalence and incidence of Mycoplasma genitalium and its macrolide resistance in men who have sex with men living in Australia: A mathematical model |
| title_full | Impact of screening on the prevalence and incidence of Mycoplasma genitalium and its macrolide resistance in men who have sex with men living in Australia: A mathematical model |
| title_fullStr | Impact of screening on the prevalence and incidence of Mycoplasma genitalium and its macrolide resistance in men who have sex with men living in Australia: A mathematical model |
| title_full_unstemmed | Impact of screening on the prevalence and incidence of Mycoplasma genitalium and its macrolide resistance in men who have sex with men living in Australia: A mathematical model |
| title_short | Impact of screening on the prevalence and incidence of Mycoplasma genitalium and its macrolide resistance in men who have sex with men living in Australia: A mathematical model |
| title_sort | impact of screening on the prevalence and incidence of mycoplasma genitalium and its macrolide resistance in men who have sex with men living in australia a mathematical model |
| url | http://www.sciencedirect.com/science/article/pii/S2589537021000596 |
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