Background Pharyngeal infection with Neisseria gonorrhoeae is usually asymptomatic and often under-diagnosed. It could therefore be an important source of ongoing transmission particularly among men who have sex with men (MSM). We investigated the prevalence and risk factors of pharyngeal infection among MSM diagnosed with gonorrhoea, and associated antimicrobial susceptibility profiles to cefixime and ceftriaxone.
Method Data from patients included in the national Gonococcal Resistance to Antimicrobials Surveillance Programme (GRASP) from 2007–2010 and self-identified as MSM were analysed. Risk factors for pharyngeal-only infection (POI) versus rectal and/or genital, infections, or a combination (RGI), were examined using multivariable logistic regression adjusting for age, clinic and year of attendance. Minimum inhibitory concentrations (MICs) of cefixime and ceftriaxone at different sites were compared using logistic regression.
Results Of the 2249 MSM in this analysis, 202 (8%) were diagnosed with a POI. They were significantly more likely to have multiple sexual partners (OR = 1.44, CI 1.0–2.1) and asymptomatic infection (OR = 13.4, CI 9.0–20.0); but less likely to report a history of gonorrhoea (OR = 0.61 CI 0.4–0.8); have a concurrent STI (OR = 0.50, CI 0.3–0.8) or be HIV-positive (OR = 0.47, CI 0.3–0.9), when compared to those with RGI. 168 (82%) of POI and 2047 (89%) of RGI cases had isolates retrieved for antimicrobial sensitivity testing. There was a two-fold increase in the geometric mean MIC of cefixime and ceftriaxone required to inhibit growth of N. gonorrheae resident in the pharynx compared to other sites (OR = 2.14; CI 1.2–3.8; OR = 2.21; CI 1.2–4.0; p < 0.05) although the proportion of isolates exhibiting decreased susceptibility to cefixime and ceftriaxone at MIC ≥ 0.125mg/l did not vary significantly.
Conclusions Patients with POI have high rates of partner change and may be at increased risk of transmitting less sensitive gonococcal strains. Screening for pharyngeal infection should be intensified. Tests of cure should be performed routinely to ensure successful treatment.
- Antimicrobial Resistance
- pharyngeal infection
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