Syndromic or Diagnostic? Tackling Antibiotic Misuse Through Neisseria Gonorrhoeae Screening Improvements in Uganda: A Theoretical Modeling Study

Abstract

Neisseria gonorrhoeae is a sexually transmitted pathogen responsible for millions of infections across Sub-Saharan Africa. In low-resource regions, gonococcal cases are predominantly diagnosed through syndromic, symptom-based management: a method with limited accuracy that contributes to high rates of improper antibiotic prescribing. As antimicrobial resistance continues to rise in low- to middle-income countries, strengthening antimicrobial stewardship has become increasingly urgent. One proposed method of reducing antibiotic misuse has been through the utilization of molecular diagnostics, which etiologically confirms an infection status. However, their impact may be limited by resource constraints, high-risk sex mixing patterns, and gender disparities in treatment-seeking behavior in rural Sub-Saharan Africa. This study addresses how improvements in gonococcal screening impact antibiotic misuse in low-resource settings with high rates of infection. Using epidemiological data from the Rakai and Kyotera districts of Uganda, we develop a mathematical model to track gonococcal disease transmission, finding that improvements in screening among men and among high-risk groups yield the most reductions in antibiotic misuse and population prevalence of N. gonorrhoeae. Ultimately, these findings highlight the potential for expanded diagnostic screening to improve antibiotic antimicrobial stewardship efforts in low-resource regions of Sub-Saharan Africa.