Objectives: This systematic review assessed the association of social determinants of health and antimicrobial resistance (AMR) in Neisseria gonorrhoeae.
Methods: Following the PRISMA checklist, literature searches were performed in three electronic databases, and screening of abstracts, data extraction, and quality assessment of individual studies was performed by one reviewer and verified by a second reviewer.
Results: The systematic review included 15 studies, without geographical limitation, in which both structural and individual determinants most explained the association with antimicrobial resistance in Neisseria gonorrhoeae. The association between older age, belong to a risk group such as men who have sex with men relative to all women and heterosexual men and having a low educational level resulted in a higher probability of developing AMR. However, while the young people were associated with faster transmission, people belonging to an older age group were associated with a higher prevalence of developing resistance in Neisseria gonorrhoeae. On the other hand, access to health services, having a below-average income level, having a high level of poverty, or having an unhealthy lifestyle (such as alcoholism or drug use) were used less to explain AMR in the studies. Given the heterogeneity of study designs, a meta-analysis was not performed.
Conclusions: Several factors related to AMR, such as risk group, sexual networks, or educational level, allow identifying the groups most vulnerable to acquiring resistance to Neisseria gonorrhoeae and to focus public intervention strategies at reducing inequalities in health outcomes.