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Management of cases testing positive for gonococcal infection in a community-based chlamydia screening programme
  1. Jennifer Downing1,
  2. Penny A Cook1,
  3. Hannah C E Madden1,
  4. Penelope A Phillips-Howard1,
  5. Stephen P Higgins2,
  6. Mark A Bellis1
  1. 1Centre for Public Health, Liverpool John Moores University, Liverpool, UK
  2. 2Department of Genitourinary Medicine, North Manchester General Hospital, Manchester, UK
  1. Correspondence to Ms Jennifer Downing, Centre for Public Health, Faculty of Applied Health and Social Sciences, Liverpool John Moores University, 3rd floor Henry Cotton Campus, 15-21 Webster Street, Liverpool L3 2ET, UK; j.downing{at}blueyonder.co.uk

Abstract

Background The National Chlamydia Screening Programme in Greater Manchester (NCSP-GM) commissioned an evaluation of the management of gonorrhoea cases identified using the Gen-Probe APTIMA Combo 2 assay (AC2).

Methods NCSP-GM provided data on gonorrhoea cases from a 6-month period (September 2007–February 2008). Data were collected from patient referral pathways to genitourinary medicine (GUM) clinics, including confirmatory testing, antibiotic resistance patterns and contact tracing. The AC2 positive predictive value (PPV) was calculated.

Results 111 individuals tested positive for gonococcal infection using AC2 (0.7% of 16 028 individuals tested). Of these, 96 (0.6% of all tested) known index cases were seen at Greater Manchester GUM clinics. 78/96 (14 men, 64 women) underwent confirmatory microscopy and gonococcal culture. Confirmatory tests were positive in 14 men (100%) but only 40 women (63%). Thus the PPV of AC2 was 69% (54/78). Sensitivity in women may have been reduced by limited partner information and sample-taking (only 28% had a full gonorrhoea screen).

Conclusion Gonorrhoea screening in an NCSP-targeted population identified gonorrhoea in a low-risk population. Subsequent management in GUM clinics was variable and limited sample-taking may have decreased the sensitivity of confirmatory testing in women. Appropriate antibiotic sensitivity tests or, in their absence, a test of cure may be needed to ensure effective treatment.

  • Community testing
  • gonorrhoea
  • screening
  • sexual health young
  • sexually transmitted infections

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Footnotes

  • Funding This work was carried out as part of an evaluation of the R U Clear? Programme in Greater Manchester and was funded by R U Clear? Programme. The funding source had no involvement in the production of this manuscript.

  • Competing interests None.

  • Ethics approval This study was classified as a service evaluation by Salford and Trafford NHS Ethics Committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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