An agent-based multi-level model to study the spread of gonorrhoea in different and interacting risk groups

Introduction: Mathematical modeling has emerged as a crucial component in understanding the epidemiology of infectious diseases. In fact, contemporary surveillance efforts for epidemic or endemic infections heavily rely on mathematical and computational methods. This study presents a novel agent-based multi-level model that depicts the transmission dynamics of gonorrhea, a sexually transmitted infection (STI) caused by the bacterium Neisseria gonorrhoeae. This infection poses a significant public health challenge as it is endemic in numerous countries, and each year sees millions of new cases, including a concerning number of drug-resistant cases commonly referred to as gonorrhea superbugs or super gonorrhea. These drug-resistant strains exhibit a high level of resistance to recommended antibiotic treatments. Methods: The proposed model incorporates a multi-layer network of agents' interaction representing the dynamics of sexual partnerships. It also encompasses a transmission model, which quantifies the probability of infection during sexual intercourse, and a within-host model, which captures the immune activation following gonorrhea infection in an individual. It is a combination of agent-based modeling, which effectively captures interactions among various risk groups, and probabilistic modeling, which enables a theoretical exploration of sexual network characteristics and contagion dynamics. Results: Numerical simulations of the dynamics of gonorrhea infection using the complete agent-based model are carried out. In particular, some examples of possible epidemic evolution are presented together with an application to a real case study. The goal was to construct a virtual population that closely resembles the target population of interest. Discussion: The uniqueness of this research lies in its objective to accurately depict the influence of distinct sexual risk groups and their interaction on the prevalence of gonorrhea. The proposed model, having interpretable and measurable parameters from epidemiological data, facilitates a more comprehensive understanding of the disease evolution.