Osman, Roeann; (2025) Feasibility and acceptability of using near real-time whole genome sequencing of Neisseria gonorrhoeae to guide clinical decision-making and individualised patient interventions. Doctoral thesis (Ph.D), UCL (University College London).

Text Osman_10219313_Thesis_sig_removed.pdf Access restricted to UCL open access staff until 1 January 2027. Download (11MB)

Abstract

Introduction: Whole genome sequencing (WGS) could improve sexual healthcare by providing insights into Neisseria gonorrhoeae (NG) transmission networks and sexual mixing. Previous research using WGS of NG isolates identified transmission clusters, including heterosexual-identifying men (HM) and men-who-have-sex-with-men (MSM). These HM might be at high risk of sexually transmitted infections (STIs), and blood-borne viruses (BBVs) found in the same network and benefit from MSM-targeted prevention messages. It might be possible to infer STI/BBV acquisition risk from the characteristics of their sexual-network as determined by NG WGS. In this multi-methods thesis, I explore the feasibility and acceptability of using NG WGS to enhance clinical decision-making and guide prevention interventions. Methods: I conducted a systematic review to understand how WGS has been used to inform patient clinical care. I conducted seven semi-structured interviews with HM and four focus group discussions with sexual health clinicians to understand acceptability and feasibility of NG WGS to inform patient care. I performed epidemiological analysis of STI surveillance datasets linked to NG WGS data to understand HM sexual mixing, HM longitudinal STI/BBV risks and agreement between clinician management and WGS risk-assessment. Results: Eight studies in the systematic review reported WGS applications to inform patient care, but none were like my work. Qualitative findings suggested broad support for using WGS in clinical management and risk-assessment, but concerns about privacy, clinician-patient trust, and ethical challenges were raised. Sexual mixing was evident between HM and MSM, and some HM demonstrated high STI/BBV rates similar to MSM. WGS-based risk assessments provided insights not found in clinical notes. Conclusion: My thesis demonstrates the potential of NG WGS to enhance risk-stratification and inform STI/BBV prevention. Findings underscore the importance of addressing ethical concerns, effective communication strategies and exploring integrating WGS data as a complementary tool alongside clinician assessments to improve patient health outcomes.

Download activity - last month

Export as XMLJSONCSV

Download activity - last 12 months

Export as JSONCSVXML

Downloads by country - last 12 months

Export as JSONCSVXML

Archive Staff Only

View Item