Gonorrhoea in the 21st century Insights in epidemiology, natural history, antimicrobial resistance, and prevention

This thesis, Gonorrhoea in the 21st Century: Insights into Epidemiology, Natural History, Antimicrobial Resistance, and Prevention, examines the evolving public health challenges posed by Neisseria gonorrhoeae in the Netherlands, with a particular focus on Amsterdam.
Using a combination of retrospective observational studies, analyses of data from a randomized controlled trial (NABOGO), and a national cross-sectional survey, this thesis explores multiple dimensions of gonorrhoea control. Epidemiological analyses describe changes in reported gonorrhoea diagnoses following the COVID-19 lockdown period and assess the presence of seasonal patterns among men who have sex with men in Amsterdam. The natural history of infection is further examined through the study of spontaneous clearance of anogenital and pharyngeal infections, highlighting implications for clinical management and antibiotic stewardship.
In addition, antimicrobial susceptibility patterns are analysed across sexual networks, identifying differences between individuals reporting exclusively Dutch and international sexual contacts. Treatment-related adverse events, including diarrhoea following ertapenem therapy, are evaluated to inform alternative treatment strategies. Preventive approaches are also assessed, including modifications in partner notification policy and the emerging informal use of doxycycline post- and pre-exposure prophylaxis.
Collectively, the findings provide comprehensive insights into the epidemiology, clinical course, antimicrobial resistance, and prevention of gonorrhoea, supporting evidence-based STI control policies and more sustainable use of antibiotics in the Netherlands.