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Original article
Comparative performance of culture using swabs transported in Amies medium and the Aptima Combo 2 nucleic acid amplification test in detection of Neisseria gonorrhoeae from genital and extra-genital sites: a retrospective study
  1. Lindsey Harryman1,
  2. Sara Scofield1,
  3. John Macleod2,
  4. David Carrington3,
  5. O Martin Williams3,
  6. Arnold Fernandes4,
  7. Paddy Horner1,2
  1. 1Bristol Sexual Health Centre, University Hospitals NHS Foundation Trust, Bristol, UK
  2. 2School of Social and Community Medicine, University of Bristol, Bristol, UK
  3. 3Health Protection Agency, Bristol, UK
  4. 4Department of Genitourinary Medicine, Royal United Hospital, Bath, UK
  1. Correspondence to Dr Paddy Horner, School of Social and Community Medicine, University of Bristol, 39 Whatley Road, Bristol BS8 2PS, UK; paddy.horner{at}


Background Nucleic acid amplification tests are being increasingly used for the routine diagnosis of Neisseria gonorrhoeae (GC), although culture remains essential for monitoring antimicrobial resistance. The authors investigated how symptoms and infection site influenced test sensitivity.

Methods This was a retrospective study at two centres of patients diagnosed as having GC by Aptima Combo 2 (AC2) confirmed with Aptima GC and/or culture.

Results The study included 251 men (71%) and 105 women (29%). The sensitivity for AC2 and culture in the lower genital tract of men with symptoms was 99% (95% CI 95% to 100%) and 79% (95% CI 71% to 85%) and for asymptomatic men was 94% (95% CI 69% to 100%) and 29% (95% CI 11% to 56%), respectively. At the rectum, the sensitivity in symptomatic men was 91% (95% CI 57% to 100%) and 55% (95% CI 25% to 82%) and in asymptomatic men 75% (95% CI 47% to 92%) and 44% (95% CI 21% to 69%) for AC2 and culture, respectively. In symptomatic women, the sensitivity from the genital site was 100% (95% CI 95% to 100%) and 53% (95% CI 38% to 68%) and for asymptomatic women 100% (95% CI 87% to 100%) and 47% (95% CI 30% to 65%) for AC2 and culture, respectively.

Conclusions The AC2 with AGC confirmation performs well at genital and extra-genital sites for detecting GC. Culture for GC using transport swabs performs poorly in asymptomatic men, symptomatic and asymptomatic women and at extra-genital sites. With the improved performance of nucleic acid amplification tests and the increase in GC antimicrobial resistance, research is needed into how best to optimise GC culture in settings where direct plating is not feasible.

  • Neisseria gonorrhoeae
  • Aptima Combo 2
  • culture
  • epidemiology
  • chlamydia
  • C trachomatis
  • chlamydia infection
  • mycoplasma
  • NGU
  • non-specific urethius

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  • LH and SS contributed equally to this manuscript.

  • Funding No funding sought.

  • Correction notice This article has been corrected since it was published Online First. The author name Mallinson has been updated in references 5 and 7.

  • Competing interests Dr Paddy Horner has been involved in a multi-centre evaluation of a new molecular diagnostic test for Chlamydia trachomatis and Neisseria gonorrhoeae by Siemens Healthcare Diagnostics Inc., for which his department received funding. None declared for other authors.

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