Background: Neisseria gonorrhoeaeinfection is the most prevalent bacterial sexually transmitted infection globally. Resistance to the last line of single dose recommended treatment has ushered in a new era of potentially untreatable gonorrhea. The goal of this research was to identify risk factors for antibiotic resistant gonorrhea infection in a highly resistant population in Shanghai, China
Methods: Epidemiologic data and biological samples were collected from symptomatic male patients and their presenting partners with laboratory confirmed gonorrhea at the Shanghai Skin Disease and STD Hospital during two periods – 2004-2005 and 2008-2011. Multi-level regression models were built to identify socioeconomic and behavioral risk factors associated with reduced susceptibility to ceftriaxone and resistance to penicillin and tetracycline, and mechanisms of resistance to penicillin and tetracycline.
Results: There was a decrease in overall (P<0.001), chromosomal (P<0.001), and plasmid-mediated (P=0.01) penicillin resistance from the first to second study period. There was a decrease in chromosomal resistance (P=0.01) and an increase (P<0.001) in plasmid-mediated resistance to tetracycline between the first and second periods of study. Male gender (P=0.03) and older age (P=0.01) were associated with reduced susceptibility to ceftriaxone. Male gender (P=0.03) and alcohol use (P=0.02) were associated with increased odds of overall tetracycline resistance. Male gender (P=0.04) was associated with increased odds of chromosomally-mediated tetracycline resistance and alcohol use (P=0.02) was associated with increased odds of plasmid-mediated tetracycline resistance. Men with incomes from 2200-5500 Yuan in the last 3 months had decreased odds (P<0.001-0.02) of plasmid-mediated resistance to tetracycline.
Conclusions: This study is one of the first to use rigorous statistical modeling to identify socioeconomic and behavioral correlates of reduced susceptibility, resistance, and mechanisms of resistance of N. gonorrhoeae to several specific drugs. The associations identified may contribute important information for gonorrhea prevention efforts in Shanghai, where levels of AMR are high.