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O05.2 Pharyngeal gonococcal infection: spontaneous clearance and persistence after treatment
  1. IPutu Yuda Hananta1,
  2. Henry John Christiaan De Vries1,
  3. Alje P Van Dam2,
  4. Martijn Sebastiaan Van Rooijen2,
  5. Hardyanto Soebono3,
  6. Maarten Franciscus Schim Van Der Loeff2,3
  1. 1Department of Dermatology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
  2. 2Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands
  3. 3Department of Dermatology And Venereology, Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta – Indonesia

Abstract

Introduction Infection of Neisseria gonorrhoeae in the pharynx (pharyngeal Ng) is associated with gonococcal transmission and development of antimicrobial resistance. We aimed to assess determinants for: (1) spontaneous clearance and (2) persistence after treatment of pharyngeal Ng.

Methods At the sexually transmitted infections clinic Amsterdam, 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). A test-of-cure (TOC) 7 days after treatment is suggested for positive cases.We retrospectively examined medical records of pharyngeal Ng patients (January 2012-August 2015). To evaluate spontaneous clearance (sub-study 1), we included patients who had follow-up NAAT result prior to antibiotic treatment. To evaluate persistence after treatment (sub-study 2), we included patients who received 500 mg ceftriaxone intramuscular injection and returned for a TOC 7–28 days after treatment.

Results In sub-study 1, 1266 cases (median time between first consultation and follow-up of 10 days [interquartile range/IQR 7–14]) were included; spontaneous clearance was found in 139 (11.0%) and was associated with age >45 years (vs 16–24 years) (aOR=1.96 [95% CI 1.06–3.60]), and with time from first consultation to follow-up (aOR=1.08 [1.06–1.10], per extra day). In sub-study 2, 781 cases (median time between first treatment and TOC of 8 days [IQR 7–12]) were included; 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) (aOR=0.36 [0.12–1.04]), and with longer time from treatment to TOC (aOR=0.74 [0.60–0.90], per extra day). In TOC 15–28 days after treatment, only 1/105 cases (1.0%) persisted.

Conclusion Spontaneous clearance of pharyngeal Ng is associated with later time of follow-up and higher age. Combining ceftriaxone with other antibiotics leads to faster clearance. TOC for pharyngeal Ng 7 days after treatment may be too soon.

Support: This study was funded by Excellence Scholarship Program (Beasiswa Unggulan), Ministry of Research, Technology and Higher Education, Republic of Indonesia and Public Health Service of Amsterdam, the Netherlands

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