Antimicrobial Resistance of Neisseria gonorrhoeae in Sub-Saharan Populations

Round 1

Reviewer 1 Report

The authors took tremendous effort in compiling the data of the earlier research and presented it in a nice way. Yet, some changes need to be taken care of to improve the manuscript to get published

1. Including a little info about some new class of antibiotics currently in use for the treatment of gonococcal infection will assist the readers to know better.
2. In the Gonococcal pathogenesis section, the writing can be modified to project the mechanism of pathogenesis rather than the in vitro and in vivo studies. Please refer to the article, http://dx.doi.org/10.1038/nrmicro.2017.169. 

Author Response

Comment 1: Including a little info about some new class of antibiotics currently in use for the treatment of gonococcal infection will assist the readers to know better.

Response: Page 10 and 11. Under heading 5 (Future treatment objectives), information regarding combination antibiotics currently in use for the treatment of gonococcal infection have been added

Comment 2: In the Gonococcal pathogenesis section, the writing can be modified to project the mechanism of pathogenesis rather than the in vitro and in vivo studies. Please refer to the article, http://dx.doi.org/10.1038/nrmicro.2017.169.

Response: On page 3 under Gonococcal pathogenesis, more mechanism of pathogenesis information had been integrated. Thank you! We found your comments extremely helpful and have revised them accordingly.

Reviewer 2 Report

In this work Authors widely descibe problem of N. gonorrhoeae infections in Sub-Saharan populations. It is important topic since N. gonorrhoeae is present on a WHO list of priority pathogens, due to wideaspread high level antibiotic resistance. Additionaly untreated gonorrhoea may lead do many complications including infertility. Overall work is comprehensive, however, not very well written. Some specific comments below: 

Lines 21-22: please check spelling of keywords, check spelling of Neisseria gonorrhoeae through the whole manuscript.

Line 25: Gram with capital letter.

Line 31: at least.

Line 40: please explain STIs.

gonococcal: not in italics.

Line 145, 166, 168: in vivo in italics. Please check through the manuscript.

Line 169: N. gonorrhoeae.

Figure 1: Please provide picture with better quality.

Line 211: p-value=0.0001, 15%

Line 221: Neisseria in italics.

Line 226: what is CT, NG? Please provide full names of microorganisms.

Line 230: Trichomonas vaginalis in italics.

Line 238: N. gonrorrhoeae.

Line 249: MIC please provide full name.

Please change: Neisseria gonorrhoeae in italics on Figure 2.

Line 325, 364: please provide full description of CDC. 

Figure 3: please enlarge determinants. 

 

 

 

 

 

Author Response

Comments:

1. Lines 21-22: please check spelling of keywords, check spelling of Neisseria gonorrhoeae through the whole manuscript.
2. Line 25: Gram with a capital letter.
3. Line 31: at least.
4. Line 40: please explain STIs.
5. gonococcal: not in italics.
6. Line 145, 166, 168: in vivo in italics. Please check through the manuscript.
7. Line 169: N. gonorrhoeae.
8. Figure 1: Please provide picture with better quality.
9. Line 211: p-value=0.0001, 15%
10. Line 221: Neisseria in italics.
11. Line 226: what is CT, NG? Please provide full names of microorganisms.
12. Line 230: Trichomonas vaginalis in italics.
13. Line 238: N. gonorrhoea.
14. Line 249: MIC please provide full name.
15. Please change: Neisseria gonorrhoeae in italics on Figure 2.
16. Line 325, 364: please provide full description of CDC.
17. Figure 3: please enlarge determinants

Responses: 

1. Neisseria gonorrhoeae spelling changed from “Neisseria gonorrhoea” to “Neisseria gonorrhoeae”, throughout the manuscript.
2. Changed from “gram-negative” to “Gram-negative”
3. The spelling of “at least” has been corrected.
4. STI has been explained in lines 26 and 27, end of the first sentence under the heading “Background”.
5. Italics removed from the word “gonococcal”
6. “in vivo” and “in vitro” have been made italics throughout the manuscript
7. Spelling corrected
8. The old figure has been replaced with a better-quality Figure.
9. The sentence construction has been changed to the structure suggested.
10. “Neisseria”, has been made in italics
11. Full names of CT and NG have been provided.
12. “Trichomonas vaginalis” has been made in italics
13. Spelling corrected
14. The full name for the abbreviation MIC has been given
15. “Neisseria gonorrhoeae” has been made in italics
16. The full name for the abbreviation CDC has been given
17. The figure has been restructured to make it possible for determinants to be enlarged.

Thank you for these excellent observations and for pointing up these obvious inaccuracies, which we have already addressed.

Reviewer 3 Report

Sexually transmitted diseases represent even in our times an important global health problem. More prevalent in developing countries, STDs imply morbidity and additional risks for HIV transmittal. The present material thoroughly analyzes available data on the topic of Neisseria gonorrhea infection, from the verges of its discovery and until now, as well as the time-frame of the antimicrobial increasing resistance.

I have a few observations for the authors:

Point 1 Reanalyze lines 78-80 and rephrase them.

Point 2 Are Sub-Saharian countries involved in public health policies to underline risk factors, symptoms, and the importance of prompt treatment for young people? If so, a subchapter that includes these data would be valuable. The changes brought by these programs should be highlighted for a future bigger policy scale.

Point 3 The Conclusions section is too large. I suggest shortening it and including some of the information in a new subsection - Limitations.

Author Response

Comment 1: Reanalyze lines 78-80 and rephrase them.

Response: Both sentences have been restructured and rephrased.

Comment 2: Are Sub-Saharan countries involved in public health policies to underline risk factors, symptoms, and the importance of prompt treatment for young people? If so, a subchapter that includes these data would be valuable. The changes brought by these programs should be highlighted for a future bigger policy scale.

Response: This section will be covered in the following scope of work, which will be focusing on Expedited Partner Therapy: Youth Knowledge and Perspectives Expedited partner therapy (EPT) being an efficient STI treatment and preventive method that allows doctors to treat the sexual partner(s) of persons diagnosed with chlamydia and/or gonorrhoea infections without a clinical examination

Comment 3: The Conclusions section is too large. I suggest shortening it and including some of the information in a new subsection - Limitations

Response: “Limitations” heading has been added and the relevant information has been moved from the Conclusion to Limitations.

Thank you for your feedback and for reminding us of the need of presenting complicated content such as hand details and scripts in a succinct and easily accessible manner.

Round 2

Reviewer 3 Report

The authors corrected and improved the overall quality of their material.

I suggest changing places between subsections 6 and 7, Conclusions and Limitations.