PT - JOURNAL ARTICLE AU - Buhari Teker AU - Henry de Vries AU - Titia Heijman AU - Alje van Dam AU - Maarten Schim van der Loeff AU - Vita Willemijn Jongen TI - Spontaneous clearance of asymptomatic anogenital and pharyngeal <em>Neisseria gonorrhoeae</em>: a secondary analysis from the NABOGO trial AID - 10.1136/sextrans-2022-055488 DP - 2022 Jul 12 TA - Sexually Transmitted Infections PG - sextrans-2022-055488 4099 - http://sti.bmj.com/content/early/2022/07/11/sextrans-2022-055488.short 4100 - http://sti.bmj.com/content/early/2022/07/11/sextrans-2022-055488.full AB - Introduction Spontaneous clearance of asymptomatic Neisseria gonorrhoeae (NG) does occur, but data are scarce. We aimed to assess spontaneous clearance among patients with asymptomatic anal, pharyngeal, vaginal and urethral NG infections who participated in the New AntiBiotic treatment Options for uncomplicated GOnorrhoea (NABOGO) trial. In addition, we assessed the determinants associated with spontaneous clearance.Methods The NABOGO trial (Trial registration number: NCT03294395) was a randomised controlled, double-blind, single-centre trial assessing non-inferiority of ertapenem, gentamicin and fosfomycin to ceftriaxone for treatment of uncomplicated gonorrhoea. For asymptomatic NABOGO participants, we collected pre-enrolment and enrolment visit samples before trial medication was given. Spontaneous clearance was defined as a positive pre-enrolment nucleic acid amplification test (NAAT) result, followed by a negative NAAT at enrolment. We compared the median time between pre-enrolment and enrolment visits for patients who cleared spontaneously and for those who did not. Determinants of spontaneous clearance were assessed using logistic regression.Results Thirty-two of 221 (14.5%) anal NG infections cleared spontaneously, 17 of 91 (18.7%) pharyngeal, 3 of 13 (23.1%) vaginal and 9 of 28 (32.1%) urethral NG infections. The median time between the pre-enrolment and enrolment visit was longer for patients who cleared their pharyngeal infection spontaneously compared with those who did not (median 8 days (IQR=7–11) vs 6 days (IQR=4–8), p=0.012); no determinants of clearance at other sites were identified. Overall, patients with more days between the pre-enrolment and enrolment visit were more likely to clear spontaneously (adjusted OR=1.06 per additional day, 95% CI 1.01 to 1.12). No association between location of NG infection and spontaneous clearance was found.Conclusions A significant proportion of asymptomatic patients cleared their NG infections spontaneously. Given these results, treatment of all NG infections after a one-time NAAT may be excessive, and more research on the natural history of NG is needed to improve antibiotic stewardship.Data are available upon reasonable request. On request to the corresponding author (vjongen@ggd.amsterdam.nl), the following data will be available after publication: de-identified participant data and statistical analysis plan. Data will be shared after approval of an analysis proposal by the first, corresponding and other coauthors (BT, HdV, TH, AvD, MSvdL and VWJ).