Perspectives of men who have sex with men on management of gonorrhoea and risk of antibiotic resistance: a reflexive thematic analysis
This reflexive thematic analysis of six interviews with men who have sex with men (MSM) reveals that while gonorrhoea is viewed as a manageable infection, awareness of antibiotic resistance is initially abstract but becomes a recognized future threat upon education, leading participants to support stewardship measures like regular testing and partner communication while viewing significant behavioral changes as unrealistic.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer
Gonorrhoea is a common bacterial infection passed between people during sex. For decades, doctors have treated it with antibiotics, medicines that kill bacteria. However, bacteria can change over time to survive these medicines, a process known as antimicrobial resistance. When this happens, the standard drugs stop working, and the infection becomes much harder to cure. This is a growing worry for public health officials because if the bacteria become resistant to all available medicines, the infection could become untreatable. People who have sex with men are affected by this infection more often than other groups, making them a key focus for understanding how to manage the disease and stop resistance from spreading. The challenge lies in balancing the need for quick treatment with the need to use antibiotics carefully so they remain effective for everyone.
Researchers in Switzerland wanted to understand how men who have sex with men think about this problem. They did not just ask for medical facts; they wanted to know how these men feel about their infections, how they handle the treatment, and what they would do if the situation changed. To find out, the team spoke with six men who had been diagnosed with gonorrhoea in the last two years. The conversations were held between October 2020 and March 2021, a time when the world was also dealing with a pandemic, which made finding participants difficult. The men came from different backgrounds, with some living with HIV and others taking medication to prevent HIV. The researchers asked them to share their stories about getting tested, receiving treatment, and managing their sex lives. Later, the researchers explained the current way gonorrhoea is treated in Switzerland and presented two imaginary situations to see how the men would react. In one scenario, a patient had to wait an extra day or two for a special test that checks if the bacteria are resistant to drugs before starting treatment. In the other, a new, faster test was available that could guide treatment but cost more and might not work for long.
The men described gonorrhoea as an unpleasant but manageable part of their lives. They told the researchers that while the infection caused discomfort and required them to stop having sex for a short time, they were rarely panicked because they knew a cure was available. Most of the men had been infected more than once, and this repeated experience made them pragmatic. They developed a routine: get tested regularly, take the medicine immediately, wait a few days, and then return to their normal lives. They did not feel that the infection changed their long-term sexual behavior. Instead, they relied on frequent testing and honest conversations with partners to keep the risk low. For those who were taking medication to prevent HIV, this approach felt natural and part of their regular health maintenance. They viewed the infection as a temporary interruption rather than a permanent threat, largely because the antibiotics they received worked every time.
When the researchers introduced the idea of antibiotic resistance, the men's reactions shifted. At first, none of them brought up the topic on their own. It was not something they worried about in their daily lives. However, once the researchers explained that bacteria could become resistant and showed them the imaginary scenarios, the men began to think more deeply about the issue. They agreed that if the standard medicines stopped working, it would be a serious and frightening problem. They worried about the possibility of an untreatable infection causing severe health issues or even death. Despite these fears, they remained hopeful that science would find new solutions before the problem became unmanageable. They believed that researchers and drug companies would develop new medicines in time. When asked what they could do personally to help stop resistance, they pointed to practical steps like getting tested often, using antibiotics only when prescribed, and talking to their partners. They did not think it was realistic to expect people to stop having sex or change their fundamental behavior to solve the problem.
The men also considered the practical side of new testing methods. When they heard about a scenario where they might have to wait a day or two for test results or pay extra for a more detailed check, they said they would likely do it themselves. They understood that waiting a short time would not ruin their day, especially since they planned to avoid sex while waiting for treatment anyway. However, they were concerned that other people in their community might not be so willing. They worried that if testing became too expensive, too slow, or too complicated, many men would stop going to the clinic. They feared this would lead to more undiagnosed infections and faster spread of the disease. They believed that for new testing strategies to work, they had to be easy to access and not create too many barriers for patients.
The study suggests that while these men understand the concept of antibiotic resistance, it remains an abstract idea to them because they have never seen it happen to themselves or their friends. Their confidence in the current system is based on the fact that the medicines have always worked for them. The researchers found that simply telling people about the risk of resistance does not automatically change how they behave. Instead, the men responded to the information by weighing the benefits of better testing against the inconvenience of waiting or paying more. They are willing to accept some extra effort for the greater good, but only if the system remains practical and accessible. The findings indicate that future plans to fight resistance must consider these real-world concerns. If new testing methods are introduced, they need to be designed in a way that does not discourage people from seeking help. The men's perspective highlights that successful public health strategies must balance the need for scientific caution with the practical realities of people's lives.
Drowning in papers in your field?
Get daily digests of the most novel papers matching your research keywords — with technical summaries, in your language.