PReventing the Emergence of untreatable STIs via radical Prevention

Resistance to common sexually transmitted infections (STIs) like gonorrhoea is increasing so fast that experts are worried that they may no longer be treatable with any antibiotics in the not too distant future. In this proposal, we want to take the first steps towards addressing the root cause of this problem. This is the excessive use of antibiotics, particularly in groups that have high rates of STIs, such as men who have sex with men (MSM) taking PrEP (a pill to prevent HIV). The link between antibiotic consumption and antibiotic resistance is frequently missed as the pathway is often not direct but goes via other commensal or ‘good’ bacteria that all of us have in our microbiomes. Antibiotics first select for resistance in the commensal bacteria, and they then pass the resistance genes on to gonorrhoea. We plan to make use of this fact to set up a system to monitor the increase in resistance in these ‘good’ bacteria that are associated with antibiotic use in populations. We will do this in our local PrEP cohort and collaborators from other centers around the world will do a similar thing. We will then use
this information to show the patients themselves as well as the doctors who care for these patients how consuming excess antibiotics leads to resistance in the ‘good’ bacteria. We expect this process will help reduce the amount of antibiotics used in these key populations and thereby address the root cause of resistance. We will also be investigating if we can find STI treatments that are less likely to
produce antibiotic resistance. One treatment we will try to develop is a bacteriophage against gonorrhoea. This is a virus that is deadly to gonorrhoea but harmless to humans and other bacteria and would enable us to treat gonorrhoea without selecting for antibiotic resistance.