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This was the first study worldwide to quantify the effect of public health interventions, such as lockdowns and social distancing, on gonorrhoea transmission that used genomic data, that is, the blueprint for all cellular data an organism needs to grow and function, collected between 2017 and 2021 in Victoria, Australia.  

 Researchers analysed nearly 6,000 genomes – the largest collection to date of Neisseria gonorrhoeae (N. gonorrhoeae), the pathogen responsible for the disease, of which there are at least 70 different strains.  

The research has been published in Nature Communications and was featured on the Nature’s Editor’s highlights page, showcasing the 50 best papers recently published in public health. 

 Gonorrhoea cases in Australia have doubled over the past decade, coinciding with increasing antimicrobial resistance. This rising issue poses a significant global public health threat, contributing to over a million deaths worldwide annually.   

 The World Health Organization (WHO) has also classified N. gonorrhoeae as a high-priority pathogen, due to its escalating treatment resistance, emphasising the urgent need for effective public health responses.   

 The University of Melbourne’s Mona Taouk, a PhD candidate in the Department of Infectious Diseases at the Doherty Institute and lead author of the paper, said social distancing during the COVID-19 pandemic temporarily reduced gonorrhoea cases, which resulted in decreased bacterial diversity.   

“We found that annual notifications of gonorrhoea dropped for the first time in 12 years during the lockdowns, but large groups of related cases, known as genomic clusters, especially among heterosexual networks and females, continued to spread,” said Ms Taouk.  

The persistence of infectious networks may indicate a lack of care directed at heterosexual groups. 

 “After restrictions were lifted, case numbers increased, but the genetic diversity of the bacteria remained low, signifying a potential narrowing of the bacterial population due to the lockdown and closure of international borders,” Ms Taouk said.   

Surprisingly, during this study, researchers found that antimicrobial resistance did not significantly contribute to these persistent transmission chains spreading the disease, with more complex factors, such as sexual behaviour and the gonorrhoea pathogen characteristics, likely to have played a more prominent role.  

The researchers posit that several key strategies should be prioritised during public health emergencies, mitigating the persistence of STIs among heterosexual couples, especially women, to effectively combat gonorrhoea and other closely transmitted infections. Key measures could include enhancing telemedicine for remote sexual health consultations, providing at-home STI testing kits and ensuring the continuity of essential services like clinics and pharmacies.  

  “For example, improving diagnostic tools and treatment options is essential, particularly in the context of rising antibiotic resistance. This includes developing rapid and accurate tests to facilitate early detection and treatment,” said Ms Taouk.   

The study also introduced a cutting-edge advanced genomic clustering method and a hierarchical statistical model, which can be used to investigate the spread of other bacterial infections transmitted through close contact, including those spread via sexual activity or respiratory droplets.  

• Peer review: Taouk M L, et al. Longitudinal genomic analysis of Neisseria gonorrhoeae transmission dynamics in Australia. Nature Communications (2024). DOI: https://doi.org/10.1038/s41467-024-52343-0  

• Collaboration:  Alfred Health, Institut Pasteur (France), Monash University, Walter and Eliza Hall Institute of Medical Research, Victorian Department of Health, University of St Andrews (Scotland), University of Glasgow (Scotland)  

• Funding:  Australian Research Council (ARC), The National Health and Medical Research Council (NHMRC), The Medical Research Future Fund (MRFF) and the Victorian Government