Targeting culture criteria to maximize culture positivity of Neisseria gonorrhoeae in three sexual health clinic settings

ObjectivesEuropean 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.MethodsApart 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.ResultsIn 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.ConclusionsConfirmation 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.

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1751High Prevalence of Rectal Neisseria gonorrhoeae and Chlamydia trachomatis Infection in Women Attending an Urban Sexual Health Clinic

Open Forum Infectious Diseases ◽

10.1093/ofid/ofu052.1297 ◽

2014 ◽

Vol 1 (suppl_1) ◽

pp. S471-S471

Author(s):

Jose Bazan ◽

Patricia Reese ◽

Allahna Esber ◽

Samantha Lahey ◽

Melissa Ervin ◽

...

Keyword(s):

Chlamydia Trachomatis ◽

Neisseria Gonorrhoeae ◽

Sexual Health ◽

Health Clinic ◽

Chlamydia Trachomatis Infection

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Prevalence and predictors of chlamydia co-infection among patients infected with gonorrhoea at a sexual health clinic in Sydney

Sexual Health ◽

10.1071/sh11146 ◽

2012 ◽

Vol 9 (4) ◽

pp. 392 ◽

Cited By ~ 5

Author(s):

David J. Templeton ◽

Niveditha Manokaran ◽

Catherine C. O'Connor

Keyword(s):

Chlamydia Trachomatis ◽

Confidence Interval ◽

Neisseria Gonorrhoeae ◽

Sexual Health ◽

Medical Records ◽

Clinic Visit ◽

Health Clinic ◽

Gram Stain ◽

Health Clinics ◽

Sexual Health Clinics

Anogenital gonorrhoea (Neisseria gonorrhoeae) is commonly diagnosed at sexual health clinics by on-site microscopy. Whether to add anti-chlamydial therapy in such situations is unclear. The medical records of all patients diagnosed with gonorrhoea between May 2005 and April 2010 at RPA Sexual Health were reviewed. Of 165 patients with anogenital gonorrhoea, 27 (16.4%, 95% confidence interval (CI) 11.1–22.9%) were co-infected with chlamydia (Chlamydia trachomatis). Compared with those only infected with anogenital gonorrhoea, there was no correlation of anogenital gonorrhoea–chlamydia co-infection with any demographic, behavioural or clinical variables examined. Anti-chlamydial therapy should be considered for all patients with gram stain diagnosed anogenital gonorrhoea at the initial clinic visit.

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Genomic assessment of within-host population variation in Neisseria gonorrhoeae: Implications for gonorrhoea transmission

10.1101/2020.08.24.20181230 ◽

2020 ◽

Author(s):

Melinda M. Ashcroft ◽

Eric P. F. Chow ◽

Darren Y. J. Lee ◽

Vesna De Petra ◽

Maree Soumilas ◽

...

Keyword(s):

Genetic Diversity ◽

Neisseria Gonorrhoeae ◽

Sexual Health ◽

Genetic Relatedness ◽

Population Variation ◽

Health Clinic ◽

Clinical Samples ◽

Anatomical Site ◽

Implicit Assumption ◽

Primary Sample

Objectives: Mathematical modelling and genomic analyses are powerful methods for investigating the transmission dynamics of Neisseria gonorrhoeae, however, often make the implicit assumption that N. gonorrhoeae isolates at different anatomical sites within the same individual are the same strain. Methods: In this study, two approaches were used to explore genetic diversity. First, we examined a collection of stored, clinical N. gonorrhoeae isolates sourced from multiple anatomical sites of single individuals attending a sexual health clinic in Melbourne from 2011-2019. Second, we obtained multiple colony picks from primary clinical samples from individuals attending a sexual health clinic in Melbourne from 2019-2020. Whole genome sequencing and a variety of bioinformatics approaches were used to determine both within-host and within-sample genetic diversity. Results: Thirty-seven individuals were identified that had cultured N. gonorrhoeae from two or more anatomical sites (urogenital, anorectal, or oropharyngeal), with a final dataset of 105 isolates. In 35/37 (94.6%) individuals, infections were highly similar at the genetic level, with identical MLST and NG-MAST profiles. Pairwise comparisons of isolates within each individual indicated that the maximum within-host pairwise SNP distance was 13 SNPs (median = 1, IQR: 0-3). Notably, four distinct multi-individual phylogenetic clusters were identified, where the maximum pairwise SNP distance was 19 SNPs (median = 6, IQR = 2-11). Similarly, comparisons of isolates within each primary sample indicated that the maximum pairwise SNP distance was 8 SNPs (median = 2, IQR:1-3). Conclusions: This study suggests that in most cases of multi-site infection, the same strain of N. gonorrhoeae causes the infection at each anatomical site. However, WGS data alone cannot differentiate between the same infecting strain or (re)infections from the same transmission network. These data guide recommendations regarding optimal bioinformatic approaches to infer genetic relatedness of N. gonorrhoeae and will help inform future studies of gonorrhoea transmission and epidemiology.

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Comparison of the FTD™ Urethritis Plus (7-Plex) detection kit with routine sexual health clinic nucleic acid amplification testing for detection of Neisseria gonorrhoeae and Chlamydia trachomatis in urine, vaginal, pharyngeal and rectal samp

10.26226/morressier.5731a408d462b8028d88c896 ◽

2016 ◽

Author(s):

Mark Harrison

Keyword(s):

Nucleic Acid ◽

Chlamydia Trachomatis ◽

Neisseria Gonorrhoeae ◽

Sexual Health ◽

Nucleic Acid Amplification ◽

Health Clinic ◽

Nucleic Acid Amplification Testing

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Detection of Neisseria gonorrhoeae and Chlamydia trachomatis from pooled rectal, pharyngeal and urine specimens in men who have sex with men

Sexually Transmitted Infections ◽

10.1136/sextrans-2017-053303 ◽

2017 ◽

Vol 94 (4) ◽

pp. 293-297 ◽

Cited By ~ 20

Author(s):

David John Speers ◽

I-Ly Joanna Chua ◽

Justin Manuel ◽

Lewis Marshall

Keyword(s):

Nucleic Acid ◽

Chlamydia Trachomatis ◽

Neisseria Gonorrhoeae ◽

Sexual Health ◽

Point Of Care ◽

Standard Of Care ◽

Urine Samples ◽

Health Clinic ◽

Sex With Men ◽

The Cost

ObjectivesScreening of men who have sex with men (MSM) for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) requires sampling from anorectal and pharyngeal sites in addition to urogenital sampling. Due to the cost of testing multiple anatomical sites individually testing of pooled specimens has potential merit. The Cepheid GeneXpert CT/NG assay (GeneXpert), which also has potential for point-of-care nucleic acid testing in the sexual health clinic, has not been assessed for pooled specimen testing.MethodsWe prospectively compared GeneXpert testing of pooled pharyngeal and rectal swabs with urine samples to standard of care testing of individual specimens from 107 participants using the Roche cobas 4800 CT/NG assay (cobas) for CT and NG in high-risk MSM attending an inner city sexual health clinic.ResultsWe found testing of pooled pharyngeal, rectal and urine samples by the GeneXpert to have 100% agreement for NG and 94% overall agreement for CT when compared with individual specimen testing by cobas. For CT testing, 14 cases were detected for both tests, 4for cobas only, 2 for GeneXpert only and 89 participants were negative for both tests.ConclusionsPooled specimen CT and NG testing by the GeneXpert was accurate when compared with single specimen testing and has potential for screening MSM for CT and NG. The role of pooled specimen testing with the GeneXpert as a point-of-care nucleic acid test in MSM requires further investigation.

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