Abstract Background Neisseria gonorrhoeae is a significant public health concern due to rising antimicrobial resistance (AMR). Current strategies for N.gonorrhoeae among GBM include frequent (3-monthly) screening however, high-frequency screening may increase ceftriaxone consumption, potentially contributing to AMR. We investigated trends in ceftriaxone prescribing among GBM attending public sexual health services (PSHS) in Australia and the association between screening frequency and ceftriaxone consumption. Methods We conducted a retrospective cohort study of GBM screened for N.gonorrhoeae at 16 Australian PSHS between 2016-2023. We classified N.gonorrhoeae tests and ceftriaxone prescriptions as screening-related (asymptomatic screening) or non-screening-related (testing/treatment of contacts, symptomatic testing or empirical treatment). We explored trends in annual ceftriaxone prescription rates and used multivariable Poisson regression to examine the association between individuals’ annual asymptomatic screening frequency and ceftriaxone consumption, adjusted for age, year, PrEP, HIV status, injecting drug use, and syphilis and chlamydia diagnoses. Results In total, 65,261 GBM contributed 133,846 person-years. Total ceftriaxone prescription rate increased from 2.92 to 5.25 defined daily dose (DDD)/100 person-year at-risk (PYAR) from 2016-2023: screening-related ceftriaxone increased from 0.91 to 2.96 DDD/100 PYAR (p0·001) whilst non-screening-related ceftriaxone remained stable (p=0.570). Compared to having one screening test per year, having ≥4 tests was associated with a higher rate of screening-related ceftriaxone prescriptions (aIRR=5·47, 95%CI=5·16-5·79). Conclusion Ceftriaxone consumption increased among GBM from 2016 to 2023, largely driven by increased N.gonorrhoeae screening rather than non-screening-related treatment. Our findings highlight the association between high-frequency screening and antibiotic consumption, providing real-world data to guide discussions on the benefits and risks of screening.
Wong et al. (Fri,) studied this question.