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Increases in pharyngeal Neisseria gonorrhoeae positivity in men who have sex with men, 2011–2015: observational study
  1. Nicholas Byron Comninos1,
  2. Linda Garton1,
  3. Rebecca Guy2,
  4. Denton Callander2,
  5. Christopher K Fairley3,4,
  6. Andrew E Grulich2,
  7. Basil Donovan2,5,
  8. Sian Louise Goddard2,6,
  9. Alison Rutherford7,8,
  10. David J Templeton1,2,9
  1. 1 RPA Sexual Health, Sydney Local Health District, Sydney, New South Wales, Australia
  2. 2 The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
  3. 3 Central Cllinical School, Monash University, Melbourne, Victoria, Australia
  4. 4 Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
  5. 5 Sydney Sexual Health Centre, South Eastern Sydney Local Health District, Sydney, New South Wales, Australia
  6. 6 Ambrose King Centre, Barts Health, National Health Service Trust, London, United Kingdom
  7. 7 School of Public Health and Community Medicine, University of New South Wales, Kensington, New South Wales, Australia
  8. 8 Illawarra Sexual Health Service, South Eastern Sydney Local Health District, Warrawong, New South Wales, Australia
  9. 9 Central Clinical School, University of Sydney, Sydney, New South Wales, Australia
  1. Correspondence to Dr Nicholas Byron Comninos, Sexual Health, RPA Sexual Health Service, Sydney, NSW 2050, Australia; nicholas.comninos{at}


Objectives Pharyngeal gonorrhoea disproportionately affects men who have sex with men (MSM). We explored temporal trends in pharyngeal gonorrhoea positivity among MSM compared with anorectal and urogenital positivity.

Methods Data (2011–2015) were extracted from 41 publicly funded sexual health clinics participating in a national surveillance network. Positivity was defined as the proportion of first-visit testing occasions where gonorrhoea was detected. Logistic regression explored trends in positivity and correlates of positive pharyngeal tests.

Results From 2011 to 2015, 24 792 MSM tested (16 710 pharyngeal, 19 810 urogenital and 15 974 anorectal first-visit tests). Pharyngeal positivity increased by 183% from 139/3509 (4.0%) in 2011 to 397/3509 (11.3%) in 2015, p-trend <0.001; urogenital positivity by 39% from 257/4615 (5.6%) to 295/3783 (7.8%), p-trend=0.006; and anorectal positivity by 87% from 160/3469 (4.6%) to 286/3334 (8.6%), p-trend <0.001. The annual temporal increase in positivity was greater in the pharynx (OR 1.33; 95% CI 1.27 to 1.38) than at urogenital (OR 1.06; 95% CI 1.02 to 1.10) and anorectal (OR 1.16; 95% CI 1.11 to 1.21) sites. Factors independently associated with pharyngeal gonorrhoea were: younger age (p<0.001), higher numbers of recent sexual partners (p-trend=0.004), contact with a person with a diagnosed STI (p<0.001), injecting drug use (p<0.001), anogenital symptoms (p<0.001) and HIV-positive status (p=0.050).

Conclusion Temporal increases in gonorrhoea positivity occurred at all anatomical sites, with the greatest increase in the pharynx. Risk factors could be used to help to develop testing and prevention strategies among MSM at highest risk. Strengthening sexual health service delivery, testing and surveillance remain priorities for pharyngeal gonorrhoea control.

  • gonorrhoea
  • epidemiology (general)
  • transmission dynamics
  • gay men

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  • Handling editor Nicola Low

  • Funding Australian Collaboration for Coordinated Enhanced Sentinel Surveillance of Sexually Transmissible Infections and Blood-borne Viruses (ACCESS) is funded by the Australian Department of Health.

  • Competing interests None declared.

  • Patient consent for publication Not required.

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