{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,8]],"date-time":"2026-01-08T21:36:39Z","timestamp":1767908199437,"version":"3.49.0"},"reference-count":29,"publisher":"Oxford University Press (OUP)","issue":"10","license":[{"start":{"date-parts":[[2024,12,14]],"date-time":"2024-12-14T00:00:00Z","timestamp":1734134400000},"content-version":"vor","delay-in-days":1,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"TB Prevention Epidemiologic and Economic Modeling Agreement","award":["5 NU38PS004651"],"award-info":[{"award-number":["5 NU38PS004651"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,10,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>Neisseria gonorrhoeae has developed resistance to all antibiotics recommended for treatment, and reports of reduced susceptibility to ceftriaxone, the last-line treatment, are increasing. Because many asymptomatic infections remain undiagnosed and most diagnosed infections do not undergo antibiotic susceptibility testing, surveillance systems may underestimate resistant infections. In this modeling study, we simulated the spread of a new strain of ceftriaxone-nonsusceptible N. gonorrhoeae in a population comprising men who have sex with men as well as heterosexual men and women. We compared scenarios with varying strain characteristics and surveillance capacity. For each scenario, we estimated 1) the number of undetected infections of the novel strain and 2) the likelihood of strain persistence in the absence of newly reported cases. Upon detection of 1 nonsusceptible isolate, the undetected burden was an estimated 5.4 infections with substantial uncertainty (95% uncertainty interval, 0-18 infections). Without additional reports of nonsusceptible infections over the subsequent 180\u00a0days, the estimate declined to 2.5 infections (95% uncertainty interval, 0-10). The likelihood of ongoing transmission also declined from 66% (95% uncertainty interval, 26-86) at first detection to 2% (95% uncertainty interval, 0-10) after 180\u00a0days. To extend the useful lifespan of last-line antibiotics, our model estimated the infection landscapes that could underlie data from surveillance systems.<\/jats:p>","DOI":"10.1093\/aje\/kwae455","type":"journal-article","created":{"date-parts":[[2024,12,14]],"date-time":"2024-12-14T16:47:12Z","timestamp":1734194832000},"page":"2861-2869","source":"Crossref","is-referenced-by-count":1,"title":["Estimating the undetected burden and the likelihood of strain persistence of drug-resistant <i>Neisseria gonorrhoeae<\/i>"],"prefix":"10.1093","volume":"194","author":[{"given":"Kirstin I","family":"Oliveira Roster","sequence":"first","affiliation":[{"name":"Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health , Boston, MA 02115 ,","place":["United States"]},{"name":"Division of STD Prevention and HIV Surveillance, Massachusetts Department of Public Health , Boston, MA 02130 ,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9292-5670","authenticated-orcid":false,"given":"Minttu M","family":"R\u00f6nn","sequence":"additional","affiliation":[{"name":"Department of Global Health and Population, Harvard T. H. Chan School of Public Health , Boston, MA 02115 ,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Heather","family":"Elder","sequence":"additional","affiliation":[{"name":"Division of STD Prevention and HIV Surveillance, Massachusetts Department of Public Health , Boston, MA 02130 ,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas L","family":"Gift","sequence":"additional","affiliation":[{"name":"Division of STD Prevention, Centers for Disease Control and Prevention , Atlanta, GA 30333 ,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kathleen A","family":"Roosevelt","sequence":"additional","affiliation":[{"name":"Division of STD Prevention and HIV Surveillance, Massachusetts Department of Public Health , Boston, MA 02130 ,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3929-5515","authenticated-orcid":false,"given":"Joshua A","family":"Salomon","sequence":"additional","affiliation":[{"name":"Department of Health Policy, Stanford University School of Medicine , Stanford, CA 94305 ,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katherine K","family":"Hsu","sequence":"additional","affiliation":[{"name":"Division of STD Prevention and HIV Surveillance, Massachusetts Department of Public Health , Boston, MA 02130 ,","place":["United States"]},{"name":"Section of Pediatric Infectious Diseases, Boston Medical Center 02118 , Boston, MA ,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yonatan H","family":"Grad","sequence":"additional","affiliation":[{"name":"Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health , Boston, MA 02115 ,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2024,12,13]]},"reference":[{"issue":"10325","key":"2025101606080424500_ref1","doi-asserted-by":"publisher","first-page":"629","DOI":"10.1016\/S0140-6736(21)02724-0","article-title":"Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis","volume":"399","author":"Murray","year":"2022","journal-title":"Lancet."},{"key":"2025101606080424500_ref2","author":"World Health Organization","year":"2015"},{"key":"2025101606080424500_ref3","year":"2022"},{"key":"2025101606080424500_ref4","year":"2024"},{"issue":"1","key":"2025101606080424500_ref5","doi-asserted-by":"publisher","first-page":"E19","DOI":"10.1111\/j.1749-6632.2011.06215.x","article-title":"Antibiotic resistance in Neisseria gonorrhoeae: origin, evolution, and lessons learned for the 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