Article Text

other Versions

Original Article
Whole genome sequencing of Neisseria gonorrhoeae reveals transmission clusters involving patients of mixed HIV serostatus
  1. Joanna Peters1,2,
  2. Fiona Cresswell3,
  3. Lauren Amor4,
  4. Kevin Cole1,2,
  5. Gillian Dean3,
  6. Xavier Didelot5,
  7. Dilrini De Silva6,
  8. David W Eyre6,
  9. John Paul1,2
  1. 1Department of Microbiology, Public Health England Collaborative Centre, Royal Sussex County Hospital, Brighton, UK
  2. 2Department of Microbiology and Infection, Royal Sussex County Hospital, Brighton, UK
  3. 3Department of HIV and Sexual Health, Claude Nicol Centre, Royal Sussex County Hospital, Brighton, UK
  4. 4Brighton and Sussex Medical School, Brighton, UK
  5. 5Department of Infectious Disease Epidemiology, Imperial College London, London, UK
  6. 6Nuffield Department of Medicine, University of Oxford, Oxford, UK
  1. Correspondence to Dr John Paul, Department of Microbiology and Infection, Royal Sussex County Hospital, Brighton BN2 5BE, UK; john.paul{at}


Objectives Prevention and control of gonorrhoea depends on understanding the nature of sexual networks and risk factors for infection. We aimed to use high-resolution typing (whole genome sequencing (WGS)) of Neisseria gonorrhoeae isolates plus patient questionnaire data to gain insights into transmission patterns in a high prevalence setting.

Methods During a 9-month period (July 2014–March 2015), patients diagnosed with gonorrhoea attending sexual health service in Brighton, UK, were invited to provide anonymised detailed information by questionnaire about risk factors for infection. Questionnaire data plus WGS data from cultured isolates were analysed to yield information about sexual networks and risk factors for infection.

Results 104/149 individuals who consented to participate in the study were culture positive. 97/104 (93%) were male. 80 self-reported to be men who have sex with men (MSM). 35/104 (34%) of patients were HIV positive. 51/104 (49%) individuals reported using geosocial networking applications to facilitate contact. Sex under the influence of drugs was reported by 16/34 (46%) of HIV-positive MSM, 17/41 (41%) of HIV-negative MSM and 5/15 (31%) of heterosexuals. WGS data were available for 100 isolates from 83 patients. 55 isolates (66%) belonged to genetically related subtypes involving one or more patients, who could be plausibly linked through recent direct or indirect transmission. Four transmission clusters containing 3–12 individuals were composed of MSM of mixed HIV serostatus.

Conclusions We show that data obtained from WGS of N. gonorrhoeae and enhanced epidemiological data obtained from patient questionnaires are mutually supportive and reveal insights into sexual networks. Our findings suggest that serosorting may have declined as a practice and indicate the importance of designing public health interventions that target infection risks associated with recreational drug use and contact made using geosocial networking applications.

  • gonorrhoea
  • neisseria gonorrhoeae
  • whole genome sequencing
  • sexual behaviour
  • sexual networks
  • HIV-serosorting

Statistics from


  • Handling editor Catherine A Ison

  • Contributors JPe, FC, GD, DDS, DWE and JPa designed the study. JPe, FC, LA and GD collected patient data and isolates. KC processed the isolates. XD, DDS and DWE did bioinformatic analysis. JPe, FC, LA, XD, DWE and JPa analysed the data. DWE prepared the figures. JPe, FC, LA, DWE and JPa wrote the manuscript, which was revised by all authors.

  • Funding The research was funded by the National Institute for Health Research Health Protection Research Unit (NIHRHPRU) in Healthcare Associated Infections and Antimicrobial Resistance at the University of Oxford in partnership with Public Health England (PHE) (HPRU-2012-10041) and the NIHR HPRU in Modelling Methodology at Imperial College London (HPRU-2012-10080) in partnership with PHE.

  • Competing interests DWE is an NIHR clinical lecturer.

  • Ethics approval Brighton and Sussex Research Ethics Committee (14/LO/0435).

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

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.