Assessing Uncertainty in an Anatomical Site-Specific Gonorrhea Transmission Model of Men Who Have Sex With Men
Assessing Uncertainty in an Anatomical Site-Specific Gonorrhea Transmission Model of Men Who Have Sex With Men
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DOI：
10.1097/olq.0000000000000953
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发表时间：
2019-05-01
影响因子：
3.1
通讯作者：
Romero-Severson, Ethan O.
中科院分区：
文献类型：
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作者：
Spicknall, Ian H.;Mayer, Kenneth H.;Romero-Severson, Ethan O.
背景淋病检测的增加突出了额外预防工作的必要性。淋病可能只有在感染和未感染的解剖部位接触时才能获得。有3个感染部位，这导致了7种可能的男男性行为（MSM）传播途径：尿道至直肠、直肠至尿道、尿道至口咽、直肠至口咽、口咽至尿道、口咽至直肠和口咽至口咽。我们的特点的不确定性和潜在的重要性，从每个解剖部位的传输使用一个确定性的房室mathematical model.Methods我们开发了一个模型，特定于网站的淋球菌感染，个人感染0，1，2，或所有3个网站。性行为和感染持续时间参数固定类似于最近的澳大利亚男男性接触者的模型分析。马尔可夫链蒙特卡罗方法被用来采样的后验分布的传播概率，符合特定的网站在美国MSM人群的特定情况下的流行率。场景被定义为传输路径是否可能或可能不通过约束特定的传输概率为零，而不是拟合them.Results传输贡献从每个站点有更大的不确定性时，更多的路线可能会传输，在最极端的情况下，当所有的路线可能会传输，口咽可以贡献0%至100%的所有传输。相比之下，当只有肛交或口交可能传播时，从口咽传播的传播仅占传播的0%至25%。干预措施的有效性，从每个网站的传播也有更大的不确定性时，更多的路线可能transmitted.Conclusions即使在理想的条件下（即，当特定地点的淋球菌的患病率，特定的性行为的相对比率，并在每个解剖部位的感染持续时间是已知的，并没有变化），淋球菌感染传播的不同解剖部位的相对重要性不能被精确地推断。需要额外的数据告知每个行为的传播性，以了解特定位点的淋球菌感染传播。这种理解对于预测特定人群的干预效果至关重要。
Background Increased gonorrhea detection highlights the need for additional prevention efforts. Gonorrhea may only be acquired when there is contact between infected and uninfected anatomical sites. With 3 sites of infection, this leads to 7 plausible routes of men who have sex with men (MSM) transmission: urethra-to-rectum, rectum-to-urethra, urethra-to-oropharynx, rectum-to-oropharynx, oropharynx-to-urethra, oropharynx-to-rectum, and oropharynx-to-oropharynx. We characterize the uncertainty and potential importance of transmission from each anatomical site using a deterministic compartmental mathematical model.Methods We developed a model of site-specific gonococcal infection, where individuals are infected at 0, 1, 2, or all 3 sites. Sexual behavior and infection duration parameters were fixed similar to a recent model analysis of Australian MSM. Markov chain Monte Carlo methods were used to sample the posterior distribution of transmission probabilities that were consistent with site-specific prevalence in American MSM populations under specific scenarios. Scenarios were defined by whether transmission routes may or may not transmit by constraining specific transmission probabilities to zero rather than fitting them.Results Transmission contributions from each site have greater uncertainty when more routes may transmit; in the most extreme case, when all routes may transmit, the oropharynx can contribute 0% to 100% of all transmissions. In contrast, when only anal or oral sex may transmit, transmission from the oropharynx can account for only 0% to 25% of transmission. Intervention effectiveness against transmission from each site also has greater uncertainty when more routes may transmit.Conclusions Even under ideal conditions (ie, when site-specific gonococcal prevalence, relative rates of specific sex acts, and duration of infection at each anatomical site are known and do not vary), the relative importance of different anatomical sites for gonococcal infection transmission cannot be inferred with precision. Additional data informing per act transmissibility are needed to understand site-specific gonococcal infection transmission. This understanding is essential for predicting population-specific intervention effectiveness.