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Confirmatory testing of Neisseria gonorrhoeae in a sexual health clinic: implications for epidemiology and treatment policy
  1. Myrte Tielemans1,
  2. Mireille van Westreenen1,
  3. Corné Klaassen1,
  4. Hannelore M Götz2,3
  1. 1Department of Medical Microbiology and Infectious Diseases, Erasmus MC, Rotterdam, Zuid-Holland, The Netherlands
  2. 2Public Health Service, Department of Infectious Disease Control, Rotterdam City Council, Rotterdam, Zuid-Holland, The Netherlands
  3. 3Department of Public Health, Erasmus MC, Rotterdam, Zuid-Holland, The Netherlands
  1. Correspondence to Dr Hannelore M Götz, Public Health Service, Department of Infectious Disease Control, Rotterdam City Council, 3000 LP Rotterdam, Zuid-Holland, The Netherlands; hm.gotz{at}rotterdam.nl

Abstract

Objectives European guidelines advise the use of dual nucleic acid amplification tests (NAAT) in order to minimise the inappropriate diagnosis of Neisseria gonorrhoeae (Ng) in urogenital samples from low prevalence areas and in extragenital specimens. In this cross-sectional study, we investigated the effect of confirmatory testing and confirmation policy on the Ng-positivity in a population visiting the sexual health clinic in Rotterdam, the Netherlands.

Methods Apart from urogenital testing, extragenital (oropharyngeal/anorectal) testing was performed for men who have sex with men (MSM) and according to sexual exposure for women and heterosexual men. Ng detection using NAAT was performed using BD Viper and for confirmatory testing BD MAX. Sexual transmitted infection consultation data were merged with diagnostic data from August 2015 through May 2016.

Results In women (n=4175), oral testing was performed in 84% and 22% were tested anally. In MSM (n=1828), these percentages were 97% and 96%, respectively. Heterosexual men (n=3089) were tested urogenitally. After confirmatory testing, oropharyngeal positivity rates decreased from 7.3% (95% CI 6.5 to 8.2) to 1.5% (95% CI 1.1 to 1.8) in women and from 13.9% (95% CI 12.3 to 15.5) to 5.4% (95% CI 4.3 to 6.4) in MSM. Anorectal positivity rates decreased from 2.6% (95% CI 1.6 to 3.7) to 1.8% (95% CI 0.9 to 2.6) in women and from 9.3% (95% CI 7.9 to 10.7) to 7.2% (95% CI 6.0 to 8.5) in MSM. Urogenital Ng-positivity rate ranged between 3.0% and 4.4% and after confirmation between 2.3% and 3.9%. When confirming oropharyngeal samples, Ng-positivity was 3.8% in women, 3.0% in heterosexual men and 12.5% in MSM. Additional confirmation of urogenital and anorectal samples led to 3.0% Ng positivity in women, 2.7% in heterosexual men and 11.4% in MSM.

Conclusions Confirmation of urogenital and anorectal samples reduced the Ng-positivity rates, especially for women. However, as there is no gold standard for the confirmation of Ng infection, the dilemma within public health settings is to choose between two evils: missing diagnoses or overtreatment. In view of the large decrease in oropharyngeal positivity, confirmation Ng-positivity in oropharyngeal samples remains essential to avoid unnecessary treatment.

  • neisseria gonorrhoeae
  • testing
  • epidemiology (general)
  • public health
  • risk factors

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Footnotes

  • Handling editor Claudia S Estcourt

  • Twitter @GotzHannelore

  • Contributors HMG, MvW and CK designed the study. MT and HMG collected the data and performed the statistical analyses. Data interpretation was performed by MvW, HMG, CK and MT. All authors contributed to drafting and revising the text and all authors approved the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The Medical Ethics Committee of the Erasmus University Medical Centre Rotterdam (MEC-2015–306) approved the anonymous use of the specimen results.

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

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