A metapopulation modelling framework for gonorrhoea and other sexually transmitted infections in heterosexual populations

Mark I. Chen, Azra C. Ghani, William Edmunds

Research output: Contribution to journalArticlepeer-review

17 Citations (Scopus)


Gonorrhoea continues to be a public health problem in the UK, and is the second most common bacterial sexually transmitted infection (STI) after chlamydia. In the UK, gonorrhoea is disproportionately concentrated in epidemiologically distinct subpopulations, with much higher incidence rates in young people, some ethnic minorities and inner city subpopulations. The original model of STI transmission proposed by Hethcote and Yorke explained some of these features through the concept of the 'core group'. Since then, several authors have modified the original model approach to include multiple sexual activity classes, but found this modelling approach to be inadequate when applied to low-prevalence settings such as the UK. We present a metapopulation framework for modelling gonorrhoea and other STIs. The model proposes that the epidemiology of gonorrhoea is largely driven by subpopulations with higher than average concentrations of individuals with high sexual risk activity. We show how this conceptualization of gonococcal epidemiology overcomes key limitations associated with some of the prior efforts to model gonorrhoea. We also use the model to explain several epidemiological features of gonorrhoea, such as its asymmetric distribution across subpopulations, and the contextual risk experienced by members of at-risk subpopulations. Finally, we extend the model to explain the distribution of other STIs, using chlamydia as an example of a more ubiquitous bacterial STI.

Original languageEnglish
Pages (from-to)775-791
Number of pages17
JournalJournal of the Royal Society Interface
Issue number38
Publication statusPublished - 6 Sep 2009


  • Chlamydia trachomatis
  • Epidemiology
  • Gonorrhoea
  • Mathematical model
  • Sexual behaviour
  • Sexually transmitted diseases


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