Acceptability of the gonorrhoea human challenge model to accelerate vaccine development in UK men

281 million people worldwide were diagnosed with a bacterial sexually transmitted infection (STI) in 2020. Antimicrobial therapy for bacterial STIs is a key contributor to antimicrobial resistance (AMR) and multidrug resistant gonorrhoea is an urgent global health threat. Development of an efficacious gonorrhoea vaccine is a global health priority to address AMR. The controlled human infection model for gonorrhoea (GC-CHIM) could accelerate gonorrhoea vaccine development. This work sought to assess the acceptability of the urogenital model to UK men.

A mixed-methods study of UK men aged 18-35 years old was undertaken to assess acceptability of the urogenital GC-CHIM to UK men and attitudes to STI research, vaccines and AMR. Participants completed an online survey indicating their agreement with a series of statements using a Likert scale. Semi-structured interviews were performed on a subset of participants to gain insight into their survey responses.

Survey responses from 72 participants and 13 interviewees highlighted stigma associated with STIs as a key barrier to, and perceived risk of, participation in STI research and GC-CHIM studies. Financial reimbursement was an important motivator, and some felt this should include compensation for intimate procedures, potential embarrassment and sexual abstinence. Individuals willing to participate in a GC-CHIM study were more likely to have personal experience of STIs, be educated to postgraduate level and describe their sexuality as gay or bisexual than those who were ambivalent or opposed to participation.

Recruitment of participants to UK urogenital GC-CHIM studies is feasible. Sexual abstinence can be a significant inconvenience for individuals that could be recognised via reimbursement. Care should be taken generalising results from STI vaccine research where participants may not be representative of the general population. Investigators in STI research should recognise stigmatisation as a potential risk for participants and promote their STI research sensitively as a means to counter misinformation and stigma.