Stop classifying Neisseria gonorrhoeae as an obligate pathogen in men who have sex with men: A viewpoint

Relman DA Falkow S . A molecular perspective of microbial pathogenicity. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. Philadelphia, PA: Elsevier, 2015, pp. 1–10.

Seifert HS . Location, location, location—commensalism, damage and evolution of the pathogenic Neisseria. J Mol Biol 2019; 431(16): 3010–3014.

Cornelissen CN . Molecular pathogenesis of Neisseria gonorrhoeae. Frontiers in Microbiology 2011; 2224.

van Bergen JE Hoenderboom BM David S , et al. Where to go to in chlamydia control? From infection control towards infectious disease control. Sex Transm Infect 2021; 97(7): 501–506.

Kenyon C Herrmann B Hughes G , et al. Management of asymptomatic sexually transmitted infections in Europe: towards a differentiated, evidence-based approach. Lancet Reg Health Eur 2023; 34: 100743.

Casadevall A Pirofski L-A . Host-pathogen interactions: redefining the basic concepts of virulence and pathogenicity. Infect Immun 1999; 67(8): 3703–3713.

Casadevall A Pirofski L-A . Host-pathogen interactions: basic concepts of microbial commensalism, colonization, infection, and disease. Infect Immun 2000; 68(12): 6511–6518.

Falkow S . Molecular Koch’s postulates applied to microbial pathogenicity. Rev Infect Dis 1988; 10: S274–S276.

Huttenhower C Gevers D Knight R , et al. Structure, function and diversity of the healthy human microbiome. Nature 2012; 486(7402): 207–214.

Heinonen PK Miettinen A . Laparoscopic study on the microbiology and severity of acute pelvic inflammatory disease. Eur J Obstet Gynecol Reprod Biol 1994; 57(2): 85–89.

Brunham R Binns B Guijon F , et al. Etiology and outcome of acute pelvic inflammatory disease. J Infect Dis 1988; 158(3): 510–517.

Vanbaelen T Tsoumanis A Florence E , et al. Effect of screening for Neisseria gonorrhoeae and Chlamydia trachomatis on incidence of these infections in men who have sex with men and transgender women taking HIV pre-exposure prophylaxis (the Gonoscreen study): results from a randomised, multicentre, controlled trial. Lancet HIV 2024; 11: e233–e244. DOI: 10.1016/S2352-3018(23)00299-0.

Barbee LA Khosropour CM Soge OO , et al. The natural history of rectal gonococcal and chlamydial infections: the ExGen study. Clin Infect Dis 2022; 74(9): 1549–1556.

Vuylsteke B Reyniers T De Baetselier I , et al. Daily and event‐driven pre‐exposure prophylaxis for men who have sex with men in Belgium: results of a prospective cohort measuring adherence, sexual behaviour and STI incidence. J Int AIDS Soc 2019; 22(10): e25407.

Tsoumanis A Hens N Kenyon CR . Is screening for chlamydia and gonorrhea in men who have sex with men associated with reduction of the prevalence of these infections? A systematic review of observational studies. Sex Transm Dis 2018; 45(9): 615–622. DOI: 10.1097/OLQ.0000000000000824.

Tsoumanis A Van Dijck C Hens N , et al. Rethinking screening intensity in terms of reducing prevalence or increasing selection pressure for the emergence of resistant gonorrhea: a modeling study of men who have sex with men in Belgium. Open Forum Infect Dis 2023; 10(4): ofad165. DOI: 10.1093/ofid/ofad165.

Marcus U Mirandola M Schink SB , et al. Changes in the prevalence of self-reported sexually transmitted bacterial infections from 2010 and 2017 in two large European samples of men having sex with men–is it time to re-evaluate STI-screening as a control strategy? PLoS One 2021; 16(3): e0248582.

Van Dijck C Laumen J Zlotorzynska M , et al. Association between STI screening intensity in men who have sex with men and gonococcal susceptibility in 21 States in the USA: an ecological study. Sex Transm Infect 2020; 96(7): 537–540. DOI: 10.1136/sextrans-2019-054313.

Kenyon C De Baetselier I Wouters K . Screening for STIs in PrEP cohorts results in high levels of antimicrobial consumption. Int J STD AIDS 2020; 31(12): 956462420957519.

Tong SY Davis JS Eichenberger E , et al. Staphylococcus aureus infections: epidemiology, pathophysiology, clinical manifestations, and management. Clin Microbiol Rev 2015; 28(3): 603–661.

Laumen JGE Van Dijck C Abdellati S , et al. Antimicrobial susceptibility of commensal Neisseria in a general population and men who have sex with men in Belgium. Sci Rep 2022; 12(9): 9.

Kenyon C . To what extent should we rely on antibiotics to reduce high gonococcal prevalence? Historical insights from mass-meningococcal campaigns. Pathogens 2020; 9(2): 134.

Weston EJ Heidenga BL Farley MM , et al. Surveillance for disseminated gonococcal infections, active bacterial core surveillance (ABCs)—United States, 2015–2019. Clin Infect Dis 2022; 75(6): 953–958.

Low N Bender N Nartey L , et al. Effectiveness of chlamydia screening: systematic review. Int J Epidemiol 2009; 38(2): 435–448.

Morris A Norris KA . Colonization by Pneumocystis jirovecii and its role in disease. Clin Microbiol Rev 2012; 25(2): 297–317.

Cover TL Blaser MJ . Helicobacter pylori in health and disease. Gastroenterology 2009; 136(6): 1863–1873.

Wetmore CM Manhart LE Lowens MS , et al. Ureaplasma urealyticum is associated with nongonococcal urethritis among men with fewer lifetime sexual partners: a case-control study. J Infect Dis 2011; 204(8): 1274–1282.

Looker KJ Johnston C Welton NJ , et al. The global and regional burden of genital ulcer disease due to herpes simplex virus: a natural history modelling study. BMJ Glob Health 2020; 5(3): e001875.

Hook IIIEW Handsfield HH . Gonococcal infections in the adult. KING K HOLMES, MD, PhD 2005;5:627.