The past, present and future of molecular testing for Neisseria gonorrhoeae in Australia: still challenging

Todd M. Pryce

doi:10.1071/MA24037

RESEARCH ARTICLE (Open Access)

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The past, present and future of molecular testing for Neisseria gonorrhoeae in Australia: still challenging

Todd M. Pryce

^A ^*

+ Author Affiliations

- Author Affiliations

^A Department of Clinical Microbiology, PathWest Laboratory Medicine WA, Fiona Stanley Hospital, Murdoch, WA 6150, Australia.

Todd Pryce is the senior medical scientist in charge of molecular diagnostics, serology and typing at the Department of Clinical Microbiology, PathWest Laboratory Medicine WA. Todd has 31-year history of working in a clinical microbiology laboratory in bacteriology, molecular diagnostics and research. Interests include qualitative and quantitative molecular methods in virology, bacteriology and mycology, Neisseria gonorrhoeae and sexually transmitted infection testing, novel multi-marker approaches for clinical laboratory testing and detection of antimicrobial resistant markers. Todd is a PhD candidate at Flinders University.

^* Correspondence to: todd.pryce@health.wa.gov.au

Microbiology Australia https://doi.org/10.1071/MA24037

Submitted: 31 May 2024 Accepted: 29 July 2024 Published: 14 August 2024

© 2024 The Author(s) (or their employer(s)). Published by CSIRO Publishing on behalf of the ASM. This is an open access article distributed under the Creative Commons Attribution 4.0 International License (CC BY).

Abstract

Nucleic-acid amplification tests (NAATs) for Neisseria gonorrhoeae, particularly earlier generation tests, have been beset with specificity problems associated with cross reaction with commensal neisseriae. This is a particular problem for extragenital samples such as pharyngeal swabs, which are loaded with commensal Neisseria species and also a common site of infection for N. gonorrhoeae. To address the specificity issues, supplementary testing (whereby samples testing positive in a screening NAAT are reflexively tested with a secondary NAAT) has been widely implemented, with associated guidelines in place in Australia since 2005. Unlike earlier generation tests, modern commercial N. gonorrhoeae NAATs are (for the most part) much improved in terms of sensitivity and specificity and some now include testing claims for oropharyngeal and anorectal sites. This has raised questions over the ongoing utility of N. gonorrhoeae supplemental testing (particularly for urogenital sites) and left supplemental testing needing to play ‘catch-up’ in terms of sensitivity compared to newer commercial NAATs. More recently, supplemental testing has found added clinical utility with the addition of antimicrobial resistance (AMR) markers. Here I present the current N. gonorrhoeae testing guidelines, recent improvements in N. gonorrhoeae NAATs, discuss the changing role of supplemental testing and future sexually transmitted infection (STI) testing needs.

Keywords: AMR, antimicrobial resistance markers, antimicrobial resistance, clinical specificity, extragenital sites, high-throughput assays, Neisseria gonorrhoeae, point-of-care testing, sexually transmitted infection, STI, supplementary testing.

Biographies

Todd Pryce is the senior medical scientist in charge of molecular diagnostics, serology and typing at the Department of Clinical Microbiology, PathWest Laboratory Medicine WA. Todd has 31-year history of working in a clinical microbiology laboratory in bacteriology, molecular diagnostics and research. Interests include qualitative and quantitative molecular methods in virology, bacteriology and mycology, Neisseria gonorrhoeae and sexually transmitted infection testing, novel multi-marker approaches for clinical laboratory testing and detection of antimicrobial resistant markers. Todd is a PhD candidate at Flinders University.

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