Objectives To determine the variation in the time from onset of symptoms to clinical presentation (time to presentation [TTP]) in a cohort of sexual health attendees with symptomatic uncomplicated genital gonorrhoea and to identify factors associated with TTP.
Methods Participants were recruited from 14 clinics across England into the ‘Gentamicin for the Treatment of Gonorrhoea (GToG)’ trial between October 2014 and November 2016. Multivariable analysis was performed using prospectively collected demographic, behavioural and clinical data in a subset of the GToG study cohort presenting with genital discharge and/or dysuria who tested positive for Neisseria gonorrhoeae using a nucleic acid amplification test. The results were expressed as geometric mean ratios (GMR) with 95% CI for time to presentation after onset of symptoms.
Results 316 participants (269 men and 47 women) with a median age of 27.6 years (IQR 23.0–34.8) were included. 194 (61%) were Caucasian, 29 (9%) Black African, 27 (9%) Asian and 66 (21%) of other ethnicities. Median TTP was 3 days for men (IQR 2–7) and 14 days for women (IQR 7–21). Participants reported genital discharge (297/316 [94%]), dysuria (251/316 [79%]), both genital discharge and dysuria (232/316 [73%]) and other concurrent symptoms 76/316 (24%) (e.g., rectal bleeding or genital itching). 45/316 (14%) participants reported sexual contact while symptomatic, of whom TTP was more than 7 days in 32/45 (71%). A longer TTP was associated with gender (female cf. male, GMR 2.34 [1.67 to 3.26]), no prior history of gonorrhoea (GMR 1.46 [1.15 to 1.86]), ‘regular’ or ‘ex-regular’ sexual relationship (regular cf. one off GMR 1.35 [1.05 to 1.72]); ex-regular cf. one off GMR 1.88 [1.12 to 3.14]), and being heterosexual (GMR 1.69 [1.31 to 2.19]).
Conclusion Specific demographic and behavioural factors are associated with a longer TTP in individuals with symptomatic genital gonorrhoea. Detailed knowledge of these factors can be used to prioritise and optimise gonorrhoea management and prevention.
- sexual behaviour
- epidemiology (general)
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Handling editor Henry John Christiaan de Vries
Correction notice The article has been corrected since it published online first. The authors noticed some typocgraphical errors in table 2 which has been amended.
Contributors JDCR conceived the study. OA, WT, TH, JDCR contributed to the design of the study. OA carried out the statistical analyses; OA, WT and TH were responsible for the statistical analysis plan. OA and JDCR drafted the manuscript. All authors assisted with interpretation of the data, reviewed and approved the final manuscript.
Funding This study was funded by the National Institute for Health Research (NIHR) Health Technology Assessment and registered prior to start of recruitment (ISRCTN51783227). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.
Competing interests JDCR reports personal fees from GSK Pharma, Hologic Diagnostics, Mycovia and Janssen Pharma as well as ownership of shares in GSK Pharma and AstraZeneca Pharma; and is author of the UK and European Guidelines on Pelvic Inflammatory Disease; is a Member of the European Sexually Transmitted Infections Guidelines Editorial Board; is a Member of the National Institute for Health Research Funding Committee (Health Technology Assessment programme); was previously a Member of the National Institute for Health Research HTA Primary Care, Community and Preventative Interventions Panel (2013–2016). He is an NIHR Journals Editor and associate editor of Sexually Transmitted Infections journal. He is an officer of the British Association for Sexual Health and HIV (vice-president), and the International Union against Sexually Transmitted Infections (treasurer), and a charity trustee of the Sexually Transmitted Infections Research Foundation. All other authors declare no competing interests
Patient consent for publication Not required.
Ethics approval Ethics approval for the 'Gentamicin for the Treatment of Gonorrhoea' trial was obtained from the Health Research Authority South Central–Oxford C Research Ethics Committee (14/SC/1030).
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Data are available upon reasonable request.
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