Background Oropharyngeal Neisseria gonorrhoeae (N. gonorrhoeae) is not routinely tested for in women visiting Dutch STI clinics. It is hypothesized that many oropharyngeal N. gonorrhoeae infections remain undetected due to its asymptomatic nature, creating a reservoir for ongoing transmission and drug resistance. It is yet unknown what the optimal testing policy is for women, as data on universal screening are missing.

Methods Surveillance data 2008–2017 from all Dutch STI clinics were used (n=546,246 consultations). Oropharyngeal testing policy was defined as (1) universal screening, that is >85% of consultations included oropharyngeal testing per clinic per year, (2) selective testing (<85% tested) or (3) incidental testing (0.1–5% tested). The proportion infections missed using selective testing was calculated by extrapolating N. gonorrhoeae positivity found by routine universal screening. Independent risk factors for oropharyngeal N. gonorrhoeae were assessed among women routinely universally screened between 2016–2017 using backward multivariable logistic regression analyses.

Results Routine universal screening was used in 11% (n=57,359) of consultations, selective testing in 81% (n=444,283) and incidental testing in 8% (n=44,108). Oropharyngeal N. gonorrhoeae positivity was comparable between universal and selective; 1.4%(95%CI 1.3–1.5,n=703), 1.4%(95%CI 1.3–1.3,n=1858,P=0.68), and higher in incidental 2.8%(95%CI 1.9–3.9,n=30, P<0.01). Selective testing missed 89% (n=5,517) of oropharyngeal infections (95%CI 88%-90%). The proportion oropharyngeal-only was 47% in routine universal screening and 52% in selective testing. Independent risk factors were being notified for any STI (OR1.3,95%CI1.03–1.5), concurrent urogenital N. gonorrhoeae (OR80.0,95%CI59.0–108.4) and commercial sex work(OR4.1,95%CI2.8–5.9). When using the risk factors except urogenital N. gonorrhoeae as testing indicators, 27.8%(n=5,418) of all women would be tested, finding 55.6% (n=119) of infections.

Conclusion Selective testing potentially misses almost 90% of oropharyngeal N. gonorrhoeae in women, of which almost half were oropharyngeal-only infections. Using two risk factors as testing indicators, half of all oropharyngeal N. gonorrhoeae infections would be detected by testing almost one-third of women. This seems like a valid and minimal testing strategy for women, as is advocated in the Dutch STI-guidelines.

Disclosure No significant relationships.