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Trends in gonorrhoea positivity by nucleic acid amplification test versus culture among Australian heterosexual men with a low prevalence of gonorrhoea, 2007–2014
  1. Patrick K Mannion1,2,
  2. Christopher K Fairley1,2,
  3. Glenda Fehler1,
  4. Sepehr N Tabrizi3,4,5,
  5. Wei Sheng Tan1,6,
  6. Marcus Y Chen1,2,
  7. Catriona S Bradshaw1,2,
  8. Eric P F Chow1,2
  1. 1Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
  2. 2Faculty of Medicine, Nursing and Health Sciences, Central Clinical School, Monash University, Melbourne, Victoria, Australia
  3. 3Department of Microbiology and Infectious Diseases, The Royal Women's Hospital, Parkville, Victoria, Australia
  4. 4Murdoch Childrens Research Institute, Parkville, Victoria, Australia
  5. 5Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Victoria, Australia
  6. 6National Skin Centre, Singapore, Singapore
  1. Correspondence to Dr Eric P F Chow, Melbourne Sexual Health Centre, 580 Swanston St, Carlton, VIC 3053, Australia; Echow{at}


Background Testing for gonorrhoea with nucleic acid amplification tests (NAATs) is not recommended in low-prevalence populations as it results in high numbers of false positive results. The aim of this study was to examine temporal trends of gonorrhoea positivity by NAAT and culture in heterosexual men in Victoria, Australia following recent increases in gonorrhoea notifications.

Methods Three data sources between 2007 and 2014 were used in this study: notification data from the Victorian Department of Health, Medicare testing numbers of single chlamydia and dual NAATs performed, and electronic records on heterosexual men attending Melbourne Sexual Health Centre (MSHC).

Results Notifications of gonorrhoea by NAAT (with/without culture) in heterosexual men in Victoria rose threefold from 74 in 2007 to 238 in 2014, while the number of dual NAATs ordered over the same period underwent a fivefold increase from 14 061 to 71 860. The overall proportion of NAATs that were positive for gonorrhoea in Victoria was low and fell from 0.53% in 2007 to 0.33% in 2014 (Ptrend=0.002). Of the 28014 new heterosexual men attending MSHC, the gonorrhoea positivity by culture was 0.9%, and chlamydia positivity by NAAT was 8.5%. The positivity of both infections did not change over time.

Conclusions These data suggest that gonorrhoea prevalence in heterosexual men is low and stable, despite annual increases in notifications. Guidelines in most countries recommend restricting testing to groups or populations with prevalence over 1%, symptomatic individuals or those at increased epidemiological risk. These data indicate gonorrhoea testing should not automatically accompany chlamydia screening in low-risk heterosexual men.

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  • Handling editor Jackie A Cassell

  • Contributors CKF and EPFC conceived and designed the study. PKM performed data analysis and wrote the first draft of the manuscript. CKF, GF and EPFC assisted in statistical analysis. CKF, SNT and EPFC involved in data interpretation. EPFC provided overall supervision of the study. CKF, SNT, WST, MYC, CSB and EPFC revised the manuscript for intellectual content. All authors read and approved the final version of the manuscript.

  • Funding This work was supported by the National Health and Medical Research Council (NHMRC) (Number 568971). EPFC is supported by the Early Career Fellowships from the Australian NHMRC (Number 1091226).

  • Competing interests None declared.

  • Ethics approval Ethics approval for this study was obtained by Alfred Health Ethics Committee (Number 507/14).

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