The clinical and public health community are facing the challenge of increasing antibiotic resistance in gonorrhea. In the search for strategies to control resistance, one proposed approach is the use of rapid diagnostics that would allow clinicians to tailor treatment to the antibiotic susceptibilities of individual infections, rather than treating empirically based on data from population-wide surveillance – in fact, efforts to develop such diagnostics are underway. However, the hypothesis motivating this strategy – that resistance emerges under antibiotic selection, so tailored therapy should prolong the utility of anti-gonococcal agents and control resistance better that the current strategy of empiric treatment – has not been evaluated.
The lack of studies on this topic has been due to lack of data on several key parameters, including the current extent of resistance in the population, likelihood of emergence of resistance on treatment, and fitness cost of resistance mutations. Using data from our related work to provide these parameters, the impact of tailored therapy on slowing the emergence and spread of antibiotic resistance in gonorrhea will be assessed, with consideration of resistance to the extended spectrum cephalosporins, macrolides, and fluoroquinolones.