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  • Persistence after treatment of pharyngeal gonococcal infections in patients of the STI clinic, Amsterdam, the Netherlands, 2012–2015: a retrospective cohort study

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Clinical
Short report
Persistence after treatment of pharyngeal gonococcal infections in patients of the STI clinic, Amsterdam, the Netherlands, 2012–2015: a retrospective cohort study
  1. I Putu Yuda Hananta1,2,
  2. Henry John Christiaan De Vries1,2,
  3. Alje P van Dam2,3,
  4. Martijn Sebastiaan van Rooijen2,
  5. Hardyanto Soebono4,
  6. Maarten Franciscus Schim van der Loeff2,5
  1. 1 Department of Dermatology, Academic Medical Center University of Amsterdam, Amsterdam, The Netherlands
  2. 2 Department of Infectious Diseases, Public Health Service (GGD), Amsterdam, The Netherlands
  3. 3 Department of Medical Microbiology, Onze Lieve Vrouwe Gasthuis (OLVG) Hospital, Amsterdam, Netherlands
  4. 4 Department of Dermatology and Venereology, Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia
  5. 5 Department of Internal Medicine, Center for Infection and Immunology Amsterdam (CINIMA), Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
  1. Correspondence to Dr Maarten Franciscus Schim van der Loeff, Department of Infectious Diseases, Public Health Service (GGD) of Amsterdam, Nieuwe Achtergracht 100, 1018 WT, Amsterdam, The Netherlands; mschimvdloeff{at}ggd.amsterdam.nl

Abstract

Introduction Infection of Neisseria gonorrhoeae in the pharynx (pharyngeal Ng) is associated with gonococcal transmission and development of antimicrobial resistance. We assessed proportion of and determinants for persistence after treatment of pharyngeal Ng.

Methods At the STI clinic of Amsterdam, the Netherlands, females-at-risk and men who have sex with men are routinely screened for pharyngeal Ng using an RNA-based nucleic acid amplification test (NAAT; Aptima Combo 2). Patients with pharyngeal Ng were invited for a test-of-cure (TOC) 7 days after treatment with a 500 mg ceftriaxone intramuscularly. We retrospectively examined medical records of patients with pharyngeal Ng (January 2012–August 2015) who returned for a TOC 7–28 days after treatment. Persistence was defined as a positive NAAT at TOC.

Results Out of 2204 pharyngeal Ng cases recorded in the study period, 781 cases (median time between first treatment and TOC of 8 (IQR 7–12) days) were included in the analysis. Persistence after treatment was found in 36 (4.6%) and was less likely among patients who received ceftriaxone in combination with other antibiotics (vs monotherapy) (adjusted OR (aOR) 0.36, 95% CI 0.12 to 1.04) and with longer time from treatment to TOC (aOR 0.74, 95% CI 0.60 to 0.90, per extra day). In those with a TOC 15–28 days after treatment, Ng persisted in only 1.0% (1/105 cases).

Conclusion A small proportion of pharyngeal Ng persists despite appropriate treatment. Combining ceftriaxone with other antibiotics appears to lead to faster clearance. A TOC for pharyngeal Ng 7 days after treatment may be too soon.

  • gonorrhoea
  • Neisseria gonorrhoeae
  • treatment
  • clinical STI care
  • testing

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/sextrans-2017-053147

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    Footnotes

    • Handling editor Jackie Cassell

    • Contributors IPYH, HJCDV, APVD and MFSVDL contributed to the design of the study. MSVR prepared the data set using clinic’s electronic medical records. IPYH performed data cleaning and analyses. IPYH prepared the manuscript draft. All authors contributed to the interpretation of data and revising the manuscript critically for important intellectual content. All authors saw and approved the final version of the manuscript. All authors agreed to be accountable for all aspects of the work.

    • Funding This work was funded by Public Health Service (GGD) of Amsterdam, the Netherlands and the Excellence Scholarship Program (Program Beasiswa Unggulan) organised by Ministry of Research, Technology and Higher Education, Republic of Indonesia.

    • Competing interests HJCDV and MFSVL served on a vaccine advisory board of GSK. Other authors have no conflict of interest to declare.

    • Patient consent Obtained.

    • Ethics approval As this was a retrospective cohort study using only routinely obtained data, no ethical clearance or informed consent was required.

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

    • Data sharing statement No additional data are available.

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