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Sampling technique and detection rates of oropharyngeal and anorectal gonorrhoea using nucleic acid amplification tests in men who have sex with men
  1. Tim Z T Yang1,
  2. Marcus Y Chen1,2,
  3. Tim R H Read1,2,
  4. Robert Needleman1,
  5. Catriona S Bradshaw1,2,
  6. Ria Fortune1,
  7. Christopher K Fairley1,2,
  8. Eric P F Chow1,2
  1. 1 Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
  2. 2 Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
  1. Correspondence to Dr Eric P F Chow, Melbourne Sexual Health Centre, 580 Swanston Street, Carlton, VIC 3053, Australia; echow{at}


Objectives The objective of this study was to examine the associations between clinicians’ self-reported sampling technique and the detection rate of gonorrhoea at the oropharynx and anorectum using a highly sensitive nucleic acid amplification test (NAAT).

Methods We analysed oropharyngeal and anorectal gonorrhoea swab results among men who have sex with men attending the Melbourne Sexual Health Centre (MSHC) between March 2015 and December 2016. Swabs were tested by NAAT using the Aptima Combo 2 transcription-mediated amplification assay due to its high sensitivity. Clinicians at MSHC were invited to complete a questionnaire on sampling techniques in November 2016. Univariable generalised estimating equations (GEE) logistic regressions were performed to determine the association between gonorrhoea detection rates and clinicians’ sampling technique. Patients’ epidemiological risk factors were included in the multivariable GEE logistic model.

Results A total of 2605 oropharyngeal gonorrhoea and 2392 anorectal gonorrhoea swab results were analysed. There was no significant difference in the detection rates of gonorrhoea between the 23 clinicians at the oropharynx (range 3.6%–16.9%, median 8.2%, P=0.302) or and anorectum (range 2.4%–17.3%, median 10.5%, P=0.177). Variations in clinicians’ self-reported sampling technique were not associated with oropharyngeal or anorectal gonorrhoea detection rates after adjusting for patients’ epidemiological risk factors.

Conclusions This study shows that differences in clinicians’ self-reported sampling technique did not result in measurable differences in the detection rate for oropharyngeal or anorectal gonorrhoea when using NAAT.

  • gonorrhoea
  • neisseria gonorrhoea
  • gay men
  • screening

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  • CKF and EPFC are joint last authors.

  • Handling editor Jackie A Cassell

  • Contributors EPFC, CKF, TRHR and MYC conceived the study and designed the questionnaire for the clinicians. TZTY performed the data analysis and wrote the first draft of the manuscript. All authors were involved in data interpretation, revised the manuscript critically for important intellectual content and approved the final version.

  • Funding This work was supported by the National Health and Medical Research Council (NHMRC) programme grant (number 568971). EPFC and TRHR are supported by the NHMRC Early Career Fellowships (EPFC: 1091226; TRHR: 1091536).

  • Competing interests None declared.

  • Ethics approval Ethical approval was obtained from the Alfred Hospital Ethics Committee, Melbourne, Australia (number 511/16).

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