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  • Self-sampling with oral rinse to detect oropharyngeal Neisseria gonorrhoeae among men who have sex with men: results from an exploratory study in Belgium (the SSONG Study)

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Original research
Self-sampling with oral rinse to detect oropharyngeal Neisseria gonorrhoeae among men who have sex with men: results from an exploratory study in Belgium (the SSONG Study)
  1. Thibaut Vanbaelen,
  2. Lida van Petersen,
  3. Maartje van Frankenhuijsen,
  4. Vicky Cuylaerts,
  5. Dorien Van den Bossche,
  6. Chris Kenyon,
  7. Irith De Baetselier
  1. Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
  1. Correspondence to Dr Thibaut Vanbaelen, Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp 2000, Belgium; tvanbaelen{at}itg.be

Abstract

Objectives We aimed to assess whether a self-collected oral rinse was non-inferior to clinician-collected oropharyngeal swabs to detect Neisseria gonorrhoeae (Ng) using culture and nucleic acid amplification tests (NAAT) among men who have sex with men (MSM), and whether Ng may still be detected in oral rinses for a minimum of 5 days after collection.

Methods MSM with a positive Ng result in an oropharyngeal or pooled sample (oropharynx, urethra and anorectum) were approached. Clinician-collected oropharyngeal swabs and oral rinses (15 mL sterile water) were taken. Ng culture and NAAT (Abbott 2000m RealTime System CT/NG assay and in-house PCR) were performed. Diagnostic accuracy was assessed using sensitivity and specificity, and agreement between both techniques using Cohen’s kappa statistic. Aliquots of positive oral rinses were left at room temperature for a minimum of 5 days and reanalysed using NAAT. Lastly, participants filled in a questionnaire to explore perceptions of both methods.

Results We included 100 participants between June 2022 and October 2023. 45 individuals (45 of 100) had a positive Ng result in either the oral rinses (42 of 45, 93%) or the swabs (36 of 45, 80%). Sensitivity was higher for oral rinses than swabs (sensitivity=0.93/0.80, specificity=1.0/1.0, respectively) and agreement between both techniques was good (kappa=0.75, p<0.001). Of the 42 positive oral rinses, 37 remained positive after a minimum of 5 days (88.1%). Using culture, 18 individuals had a positive Ng result in either the oral rinses (8 of 18, 44%) or the swabs (16 of 18, 88%). Most participants found the oral rinse easy or very easy to use and would be willing to use the oral rinse for home-based sampling.

Conclusion We detected more oropharyngeal Ng infections via NAAT using oral rinses than swab samples. However, swabs were better than oral rinses for culturing Ng. Oral rinses might allow for home-based self-sampling to detect oropharyngeal Ng.

  • NEISSERIA GONORRHOEAE
  • Diagnostic Techniques and Procedures
  • MICROBIOLOGY

Data availability statement

Data are available upon reasonable request. The data supporting the findings of this study are retained at the Institute of Tropical Medicine, Antwerp, and will not be made openly accessible due to ethical and privacy concerns. Data can however me made available after approval of a motivated and written request to the Institute of Tropical Medicine at ITMresearchdataaccess@itg.be.

https://doi.org/10.1136/sextrans-2023-056059

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    Data availability statement

    Data are available upon reasonable request. The data supporting the findings of this study are retained at the Institute of Tropical Medicine, Antwerp, and will not be made openly accessible due to ethical and privacy concerns. Data can however me made available after approval of a motivated and written request to the Institute of Tropical Medicine at ITMresearchdataaccess@itg.be.

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    Footnotes

    • Handling editor Nadja A Vielot

    • Contributors TV and IDB conceptualised the study. TV, VC, DvdB, CK and IDB developed the methodology. TV, LvP, MvF, CK and VC performed the investigation. TV performed the formal analysis. TV wrote the original draft. All authors contributed significantly to this manuscript and have approved the final version. TV acted as a guarantor.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

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

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.