Neisseria gonorrhoeae positivity in clients presenting as asymptomatic contacts of gonorrhoea at a sexual health centre
Sue Qian A E , Rosalind Foster B C , Christopher Bourne B C , Tobias Vickers
B C , Ruthy McIver B and Anna McNulty B D
A Sydney Medical School, The University of Sydney, Camperdown, NSW 2006, Australia.
B Sydney Sexual Health Centre, PO Box 1614, Sydney, NSW 2001, Australia.
C Kirby Institute, The University of New South Wales, Kensington, NSW 2052, Australia.
D School of Public Health and Community Medicine, The University of New South Wales, Kensington, NSW 2052, Australia.
E Corresponding author. Email: sqia1520@uni.sydney.edu.au
Sexual Health 17(2) 187-191 https://doi.org/10.1071/SH19091
Submitted: 14 August 2019 Accepted: 25 November 2019 Published: 28 February 2020
Abstract
Background: Previous guidelines at the Sydney Sexual Health Centre (SSHC) recommended empirical antibiotic treatment for asymptomatic contacts of Neisseria gonorrhoeae at the time of testing. With increasing concerns around gonorrhoea antibiotic resistance, it has been suggested that asymptomatic contacts should only be treated based on test results. Methods: This retrospective study of data from the SSHC electronic medical record included a total of 295 gonorrhoea contacts from 1 January 2018 to 30 June 2018. The primary outcome was the proportion of asymptomatic gonorrhoea contacts with a positive gonorrhoea result from any anatomical site. Statistically significant differences in gonorrhoea positivity according to gender, sexual preference, use of PrEP, sex worker status, country of birth, preferred language and number of partners, were calculated using Fisher’s exact test. Results: The overall proportion of asymptomatic gonorrhoea contacts with a positive gonorrhoea result was 27.1% (95% CI: 22.1–32.6%). The proportion of gonorrhoea positivity was significantly higher in females compared to males (52.0% vs 25.7%, P < 0.01), gay and bisexual men compared to heterosexual men (28.7% vs 0%, P < 0.01) and non-users of PrEP compared to PrEP users (31.2% vs 12.5%, P < 0.05). No statistically significant differences in gonorrhoea positivity were found in subgroups divided by sex worker status, country of birth, preferred language and number of partners. Conclusion: The relatively low gonorrhoea positivity rate (27.1%) in asymptomatic gonorrhoea contacts at the SSHC between January and June 2018 supports guideline changes to no longer provide empirical antibiotic treatment to asymptomatic contacts.
Additional keywords: antibiotic resistance, empirical treatment, sexually transmissible infections.
References
[1] Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM). Australasian contact tracing guidelines: gonorrhoea. Sydney: ASHM; 2016. Available online at: http://contacttracing.ashm.org.au/conditions/when-contact-tracing-is-recommended/gonorrhoea [verified 6 December 2018].[2] Low N, Unemo M, Jensen JS, Breuer J, Stephenson JM. Molecular diagnostics for gonorrhoea: implications for antimicrobial resistance and the threat of untreatable gonorrhoea. PLoS Med 2014; 11 e1001598
| Molecular diagnostics for gonorrhoea: implications for antimicrobial resistance and the threat of untreatable gonorrhoea.Crossref | GoogleScholarGoogle Scholar | 24503544PubMed |
[3] HealthStats NSW. Gonorrhoea notifications. Sydney: NSW Ministry of Health; 2016. Available online at: http://www.healthstats.nsw.gov.au/Indicator/com_gononot [verified 6 December 2018].
[4] Bartelsman M, Vaughan K, Rooijen MS, Vries HJC, Xiridou M. Impact of point-of-care management on the transmission of anogenital gonococcal infections among men who have sex with men in Amsterdam: a mathematical modelling and cost-effectiveness study. Sex Transm Infect 2018; 94 174–9.
| 28942419PubMed |
[5] Leeyaphan C, Jiamton S, Chanyachailert P, Surawan T, Omcharoen V. Treatment outcomes and loss to follow-up rate of male patients with gonococcal and nongonococcal urethritis who attended the sexually transmitted disease clinic: an 8-year retrospective study. Indian J Sex Transm Dis AIDS 2017; 38 37–42.
| Treatment outcomes and loss to follow-up rate of male patients with gonococcal and nongonococcal urethritis who attended the sexually transmitted disease clinic: an 8-year retrospective study.Crossref | GoogleScholarGoogle Scholar | 28442801PubMed |
[6] Tsadik M, Berhane Y, Worku A, Wondwossen T. The magnitude of, and factors associated with, loss to follow-up among patients treated for sexually transmitted infections: a multilevel analysis. BMJ Open 2017; 7 e016864
| The magnitude of, and factors associated with, loss to follow-up among patients treated for sexually transmitted infections: a multilevel analysis.Crossref | GoogleScholarGoogle Scholar | 28716795PubMed |
[7] Bignell C, Unemo M. 2012 European guidelines on the diagnosis and treatment of gonorrhoea in adults: gonococcal infections. Copenhagen: Statens Serum Institut; 2012. Available online at: https://www.iusti.org/regions/Europe/pdf/2012/Gonorrhoea_2012.pdf [verified 6 December 2018].
[8] Centers for Disease Control and Prevention. 2015 sexually transmitted diseases treatment guidelines. Atlanta: U.S. Department of Health & Human Services; 2015. Available online at: https://www.cdc.gov/std/tg2015/gonorrhea.htm [verified 6 December 2018].
[9] Ng LK, Martin IE. The laboratory diagnosis of Neisseria gonorrhoeae. Can J Infect Dis Med Microbiol 2005; 16 15–25.
| The laboratory diagnosis of Neisseria gonorrhoeae.Crossref | GoogleScholarGoogle Scholar | 18159523PubMed |
[10] Wright S, McNulty A. Test positivity in asymptomatic men who have sex with men who present as a contact of gonorrhoea – should we change practice? Poster session presented at Australian Sexual Health Conference; 14–16 November 2015; Adelaide, SA, Australia. 2016. Available online at: https://www.eiseverywhere.com/file_uploads/fbf10d3be620dcf5d99f031e5bce5501_SimonWright395.pdf [verified 9 January 2020].
[11] Dutt K, Chow EPF, Huffman S, Klassen K, Fairley CK, Bradshaw CS, et al High prevalence of rectal gonorrhoea among men reporting contact with men with gonorrhoea: implications for epidemiological treatment. BMC Public Health 2015; 15 658
| High prevalence of rectal gonorrhoea among men reporting contact with men with gonorrhoea: implications for epidemiological treatment.Crossref | GoogleScholarGoogle Scholar | 26170131PubMed |
[12] Pearce E, Chan DJ, Smith DE. Empiric antimicrobial treatment for asymptomatic sexual contacts of sexually transmitted infection in the era of antimicrobial resistance: time to rethink? Int J STD AIDS 2019; 30 137–39.
| Empiric antimicrobial treatment for asymptomatic sexual contacts of sexually transmitted infection in the era of antimicrobial resistance: time to rethink?Crossref | GoogleScholarGoogle Scholar | 30293504PubMed |
[13] Unemo M, Shafer WM. Antibiotic resistance in Neisseria gonorrhoeae: origin, evolution, and lessons learned for the future. Ann N Y Acad Sci 2011; 1230 E19–28.
| Antibiotic resistance in Neisseria gonorrhoeae: origin, evolution, and lessons learned for the future.Crossref | GoogleScholarGoogle Scholar | 22239555PubMed |
[14] Ison CA, Town K, Obi C, Chisholm S, Hughes G, Livermore DM. Decreased susceptibility to cephalosporins among gonococci: data from the Gonococcal Resistance to Antimicrobials Surveillance Programme (GRASP) in England and Wales. Lancet 2013; 13 762–8.
| Decreased susceptibility to cephalosporins among gonococci: data from the Gonococcal Resistance to Antimicrobials Surveillance Programme (GRASP) in England and Wales.Crossref | GoogleScholarGoogle Scholar | 23764300PubMed |
[15] World Health Organization. Antibiotic-resistant gonorrhoea on the rise, new drugs needed. Geneva: World Health Organization; 2017. Available online at: http://www.who.int/news-room/detail/07-07-2017-antibiotic-resistant-gonorrhoea-on-the-rise-new-drugs-needed [verified 6 December 2018].
[16] Ohnishi M, Saika T, Hoshina S, Iwasaku K, Nakayama S, Watanabe H, et al Ceftriaxone-resistant Neisserisa gonorrhoeae, Japan. Emerg Infect Dis 2011; 17 148–9.
| Ceftriaxone-resistant Neisserisa gonorrhoeae, Japan.Crossref | GoogleScholarGoogle Scholar | 21192886PubMed |
[17] Public Health England. UK case of Neisseria gonorrhoeae with high-level resistance to azithromycin and resistance to ceftriaxone acquired abroad. Health Protection Report 2018; 12 1–4.
[18] Whiley DM, Jennison A, Pearson J, Lahra MM. Genetic characterisation of Neisseria gonorrhoeae resistant to both ceftriazone and azithromycin. Lancet Infect Dis 2018; 18 717–8.
| Genetic characterisation of Neisseria gonorrhoeae resistant to both ceftriazone and azithromycin.Crossref | GoogleScholarGoogle Scholar | 29976521PubMed |
[19] Kojima N, Davey DJ, Klausner JD. Pre-exposure prophylaxis for HIV infection and new sexually transmitted infections among men who have sex with men. AIDS 2016; 30 2251–2.
| Pre-exposure prophylaxis for HIV infection and new sexually transmitted infections among men who have sex with men.Crossref | GoogleScholarGoogle Scholar | 27314179PubMed |
[20] Whitlock GG, Gibbons DC, Longford N, Harvey MJ, McOwan A, Adams EJ. Rapid testing and treatment for sexually transmitted infections improve patient care and yield public health benefits. Int J STD AIDS 2018; 29 474–82.
| Rapid testing and treatment for sexually transmitted infections improve patient care and yield public health benefits.Crossref | GoogleScholarGoogle Scholar | 29059032PubMed |
[21] Natoli L, Maher L, Shephard M, Hengel B, Tangey A, Badman SG, et al Point-of-care testing for chlamydia and gonorrhea: implications for clinical practice. PLoS One 2014; 9 e100518
| Point-of-care testing for chlamydia and gonorrhea: implications for clinical practice.Crossref | GoogleScholarGoogle Scholar | 24956111PubMed |
[22] Warner L, Stone KM, Macaluso M, Buehler JW, Austin HD. Condom use and risk of gonorrhea and chlamydia: a systematic review of design and measurement factors assessed in epidemiologic studies. Sex Transm Dis 2006; 33 36–51.
| Condom use and risk of gonorrhea and chlamydia: a systematic review of design and measurement factors assessed in epidemiologic studies.Crossref | GoogleScholarGoogle Scholar | 16385221PubMed |
[23] Fifer H, Saunders J, Soni S, Sadiq ST, Fitzgerald M. British Association for Sexual Health and HIV national guideline for the management of infection with Neisseria gonorrhoeae. Cheshire: British Association for Sexual Health and HIV; 2019. Available online at: https://www.bashh.org/guidelines [verified 17 October 2019].
[24] FitzGerald M, Bedford C. National standards for the management of gonorrhoea. Int J STD AIDS 1996; 7 298–99.
| National standards for the management of gonorrhoea.Crossref | GoogleScholarGoogle Scholar | 8876366PubMed |
[25] Bromhead C, Miller A, Jones M, Whiley D. Comparison of the cobas 4800 CT/NG test with culture for detecting Neisseria gonorrhoeae in genital and nongenital specimens in a low prevalence population in New Zealand. J Clin Microbiol 2013; 51 1505–9.
| Comparison of the cobas 4800 CT/NG test with culture for detecting Neisseria gonorrhoeae in genital and nongenital specimens in a low prevalence population in New Zealand.Crossref | GoogleScholarGoogle Scholar | 23467604PubMed |
[26] Chow EPF, Chen MY, Williamson DA, Bradshaw CS, Vodstrcil LA, Trumpour S, et al Oropharyngeal and genital gonorrhea infections among women and heterosexual men reporting sexual contact with partners with gonorrhea: implication for oropharyngeal testing of heterosexual gonorrhea contacts. Sex Transm Dis 2019; 46 743–7.
| Oropharyngeal and genital gonorrhea infections among women and heterosexual men reporting sexual contact with partners with gonorrhea: implication for oropharyngeal testing of heterosexual gonorrhea contacts.Crossref | GoogleScholarGoogle Scholar | 31517767PubMed |
