Antimicrobial resistance in Neisseria gonorrhoeae among men on PrEP in Vietnam

PROJECT SUMMARY/ABSTRACT
Antimicrobial resistance (AMR) is a global health emergency. Neisseria gonorrhoeae is a high-priority pathogen
for AMR, as there are 87 million infections per year worldwide and the bacteria has demonstrated resistance to
every class of antibiotics recommended for its treatment. Treatment failures have been reported, typically involve
oropharyngeal infections, and are dire warnings that the era of untreatable gonorrhea is near. In the Western
Pacific Region, which includes Vietnam, resistance to ceftriaxone and azithromycin, the most commonly
recommended antibiotic therapy for gonorrhea, are increasing. Men who have sex with men (MSM) are
disproportionately affected by AMR in N. gonorrhoeae infections, but remain under-represented in data from low-
and middle-income countries (LMICs). The proposed study seeks to better understand AMR in N. gonorrhoeae
by embedding new research into an existing HIV pre-exposure prophylaxis (PrEP) program for MSM in Vietnam.
The study aims are 1) to determine the prevalence of and risk factors for AMR in N. gonorrhoeae among MSM
in a PrEP program in Vietnam; 2) to measure the frequency of pharyngeal N. gonorrhoeae treatment failures
and the association between pharyngeal infections and AMR; and 3) to use whole-genome sequencing (WGS)
to conduct a genomic epidemiology study of N. gonorrhoeae nested within our study population of MSM in a
PrEP program in Vietnam. The study will leverage regular testing for N. gonorrhoeae and follow-up that occur
through the PrEP program to shed new light on the issue of AMR in N. gonorrhoeae within this key population.
This Fogarty International Research Scientist Development Award (K01) is to support the career development
of Dr. Paul Adamson, an infectious diseases physician whose goal is to become an independent global health
investigator at the intersection of AMR and sexually transmitted infections (STIs). The K01 will support Dr.
Adamson to develop expertise in 1) clinical microbiology and AMR testing, 2) WGS, bioinformatics, and genomic
epidemiology, and 3) advanced training in clinical trials research with a focus in LMICs. To achieve the proposed
research and training aims, Dr. Adamson has assembled a mentorship team with proven experience mentoring
early-career investigators and with expertise in STIs, epidemiology, AMR, biostatistics, and genomics. Drs.
Pamina Gorbach (UCLA) and Le Minh Giang (Hanoi Medical University, HMU) will serve as Primary Mentors
and have extensive experience in conducting large-scale prevention research studies and clinical trials on STIs
and HIV among MSM. In addition, his Co-Mentorship team includes Dr. Jeffrey Klausner, a US-based global
health researcher and an international expert on STIs and AMR in N. gonorrhoeae, and Dr. Nguyen Vu Trung,
a Vietnam-based researcher with expertise in clinical microbiology and antibiotic susceptibility testing in N.
gonorrhoeae. The proposed research and training aims leverage the strong research collaborations and the
robust research infrastructure that exist between UCLA and HMU. The IRSDA will advance Dr. Adamson's career
as an expert in STIs and AMR and establish him as an independent global health investigator.

Grant Number: 5K01TW012170-05
NIH Institute/Center: NIH
Principal Investigator: Paul Adamson