Quantifying superspreading in bacterial STI outbreaks using phylodynamics

Bacterial sexually transmitted infections (STIs) pose a major global public health challenge, with Neisseria gonorrhoeae being of particular concern due to its persistently high prevalence and increasing antimicrobial resistance. The emergence of multidrug-resistant strains has narrowed treatment options, highlighting the importance of prevention. In this context, knowing whether there is superspreading (transmission heterogeneity) within a population becomes crucial for accurate public health measures. However, classic methods to quantify superspreading rely on dense contact tracing, and this is not always feasible. As an alternative, we can use Bayesian phylodynamic modelling to infer transmission dynamics, including superspreading. Yet modelling transmission dynamics using bacterial data remains problematic, although it is widely used for viral data. Here, we apply a multi-type birth-death model parametrised to quantify superspreading in N. gonorrhoeae outbreaks, estimating the fraction and relative impact of superspreaders and reproductive numbers for superspreaders and non-superspreaders. We also use a hierarchical modelling strategy with partial pooling to increase the power for detecting superspreading in each cluster. Model performance was successfully evaluated across a range of superspreading scenarios using both transmission-informed phylogenies and sequence data with phylogenetic uncertainty. Application to empirical genomic data revealed a substantial role of superspreading in N. gonorrhoeae transmission during the COVID-19 pandemic in Australia. These results highlight the impact of superspreading in N. gonorrhoeae transmission and the importance of detecting it to efficiently stop the dissemination of the disease