The Impact of Rapid Drug Susceptibility Tests on Gonorrhea Burden and the Life Span of Antibiotic Treatments: A Modeling Study Among Men Who Have Sex With Men in the United States

Am J Epidemiol. 2024 Jan 8;193(1):17-25. doi: 10.1093/aje/kwad175.


Rapid point-of-care tests that diagnose gonococcal infections and identify susceptibility to antibiotics enable individualized treatment. This could improve patient outcomes and slow the emergence and spread of antibiotic resistance. However, little is known about the long-term impact of such diagnostics on the burden of gonorrhea and the effective life span of antibiotics. We used a mathematical model of gonorrhea transmission among men who have sex with men in the United States to project the annual rate of reported gonorrhea cases and the effective life span of ceftriaxone, the recommended antibiotic for first-line treatment of gonorrhea, as well as 2 previously recommended antibiotics, ciprofloxacin and tetracycline, when a rapid drug susceptibility test that estimates susceptibility to ciprofloxacin and tetracycline is available. The use of a rapid drug susceptibility test with ≥50% sensitivity and ≥95% specificity, defined in terms of correct ascertainment of drug susceptibility and nonsusceptibility status, could increase the combined effective life span of ciprofloxacin, tetracycline, and ceftriaxone by at least 2 years over 25 years of simulation. If test specificity is imperfect, however, the increase in the effective life span of antibiotics is accompanied by an increase in the rate of reported gonorrhea cases even under perfect sensitivity.

Keywords: drug resistance; gonococcal infection; gonorrhea; mathematical models; rapid diagnosis; simulation.

MeSH terms

  • Anti-Bacterial Agents / pharmacology
  • Anti-Bacterial Agents / therapeutic use
  • Ceftriaxone / pharmacology
  • Ceftriaxone / therapeutic use
  • Ciprofloxacin / pharmacology
  • Ciprofloxacin / therapeutic use
  • Drug Resistance, Bacterial
  • Gonorrhea* / drug therapy
  • Gonorrhea* / epidemiology
  • Homosexuality, Male
  • Humans
  • Longevity
  • Male
  • Microbial Sensitivity Tests
  • Neisseria gonorrhoeae
  • Sexual and Gender Minorities*
  • Tetracycline / pharmacology
  • Tetracycline / therapeutic use
  • United States / epidemiology


  • Anti-Bacterial Agents
  • Ceftriaxone
  • Ciprofloxacin
  • Tetracycline