Time trends in positive gonorrhoea diagnoses at the Christchurch Sexual Health Service (2012–2022): a data audit study
Hayley J. Denison
A * , Julie Creighton B , Jeroen Douwes A , Maureen Coshall C and Heather Young C
A
B
C
Abstract
Gonorrhoea infections and antimicrobial resistance are rising in many countries, particularly among men who have sex with men, and an increasing proportion of infection is detected at extragenital sites. This study assessed trends in gonorrhoea diagnoses and antibiotic resistance at a sexual health service in New Zealand that followed national guidelines for specimen collection.
Routinely-collected data from Canterbury Health Laboratories of specimens taken at the Christchurch Sexual Health Service 2012–2022 were audited. Descriptive results included the number of patient testing events positive for gonorrhoea per year and site of infection (extragenital/urogenital). Annual test-positivity was calculated (number of positive patient testing events divided by total number of testing events) and the Cochran-Armitage Test for Trend was used to assess whether there was an association between test-positivity and year.
Of 52,789 patient testing events, 1467 (2.8%) were positive for gonorrhoea (81% male). Half (49.3%) of people (57.9% of males, 12.2% of females) with a gonorrhoea infection had an extragenital infection in the absence of a urogenital infection. The number of extragenital infections increased at a faster rate than urogenital among males. Test-positivity increased from 1.3% in 2012 to 5.8% in 2022 (P < 0.001). Antimicrobial resistance was identified in many isolates. Ciprofloxacin resistance was high, but there were no cases of ceftriaxone resistance.
This study highlights the importance of extragenital sampling and maintaining bacterial culture methods for accurate diagnosis and treatment. The observation that gonorrhoea positivity rate and antimicrobial resistance rates are rising in New Zealand calls for urgent action.
Keywords: antibiotic susceptibility testing, antimicrobial resistance, diagnosed infection, extragenital infection, gonorrhoea, impacts of covid, Neisseria gonorrhoeae, sexual health service use, test positivity, trends over time.
References
1 Quillin SJ, Seifert HS. Neisseria gonorrhoeae host adaptation and pathogenesis. Nat Rev Microbiol 2018; 16(4): 226-240.
| Crossref | Google Scholar | PubMed |
2 Newman L, Rowley J, Vander Hoorn S, Wijesooriya NS, Unemo M, Low N, et al. Global estimates of the prevalence and incidence of four curable sexually transmitted infections in 2012 based on systematic review and global reporting. PLoS ONE 2015; 10(12): e0143304.
| Crossref | Google Scholar | PubMed |
3 Skerlev M, Culav-Koscak I. Gonorrhea: new challenges. Clin Dermatol 2014; 32(2): 275-281.
| Crossref | Google Scholar | PubMed |
4 Gimenes F, Souza RP, Bento JC, Teixeira JJV, Maria-Engler SS, Bonini MG, et al. Male infertility: a public health issue caused by sexually transmitted pathogens. Nat Rev Urol 2014; 11(12): 672-687.
| Crossref | Google Scholar | PubMed |
5 Unemo M, Shafer WM. Antimicrobial resistance in Neisseria gonorrhoeae in the 21st century: past, evolution, and future. Clin Microbiol Rev 2014; 27(3): 587-613.
| Crossref | Google Scholar | PubMed |
6 Unemo M, Lahra MM, Escher M, Eremin S, Cole MJ, Galarza P, et al. WHO global antimicrobial resistance surveillance for Neisseria gonorrhoeae 2017-18: a retrospective observational study. Lancet Microbe 2021; 2(11): e627-e636.
| Crossref | Google Scholar | PubMed |
7 Unemo M, Lahra MM, Cole M, Galarza P, Ndowa F, Martin I, et al. World Health Organization Global Gonococcal Antimicrobial Surveillance Program (WHO GASP): review of new data and evidence to inform international collaborative actions and research efforts. Sex Health 2019; 16(5): 412-425.
| Crossref | Google Scholar | PubMed |
8 Tacconelli E, Carrara E, Savoldi A, Harbarth S, Mendelson M, Monnet DL, et al. Discovery, research, and development of new antibiotics: the WHO priority list of antibiotic-resistant bacteria and tuberculosis. Lancet Infect Dis 2018; 18(3): 318-327.
| Crossref | Google Scholar | PubMed |
9 Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance, 2021. Available at https://www.cdc.gov/std/statistics/2022/2021-STD-Surveillance-Report-PDF_ARCHIVED-2-16-24.pdf [Accessed 20 June 2024]
11 UK Health Security Agency. Official Statistics. Sexually transmitted infections (STIs): annual data tables. Table 1a: new STI diagnosis numbers and rates in England by gender, 2013 to 2022. 2024. Available at https://www.gov.uk/government/statistics/sexually-transmitted-infections-stis-annual-data-tables [Accessed 5 July 2023]
12 Institute of Environmental Science and Research. New Zealand Sexually Transmitted Infection (STI) Surveillance Dashboard. 2024. Available at https://www.esr.cri.nz/our-research/nga-kete/infectious-disease-intelligence/sexually-transmitted-infection-sti-surveillance/ [Accessed 5 July 2023]
13 Saxton PJW, McAllister SM, Thirkell CE, Ludlam AH, Bateman JP, Anglemyer AT, et al. Population rates of HIV, gonorrhoea and syphilis diagnoses by sexual orientation in New Zealand. Sex Transm Infect 2022; 98(5): 376-379.
| Crossref | Google Scholar | PubMed |
14 Kirkcaldy RD, Weston E, Segurado AC, Hughes G. Epidemiology of gonorrhoea: a global perspective. Sex Health 2019; 16(5): 401-411.
| Crossref | Google Scholar | PubMed |
15 Comninos NB, Garton L, Guy R, Callander D, Fairley CK, Grulich AE, et al. Increases in pharyngeal Neisseria gonorrhoeae positivity in men who have sex with men, 2011-2015: observational study. Sex Transm Infect 2020; 96(6): 432-435.
| Crossref | Google Scholar |
16 Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM) and New Zealand Sexual Health Society (NZSHS). Aotearoa New Zealand, STI management guidelines for use in primary care. 2024. Available at https://sti.guidelines.org.nz/ [Accessed 5 July 2023]
18 Chan PA, Robinette A, Montgomery M, Almonte A, Cu-Uvin S, Lonks JR, et al. Extragenital infections caused by Chlamydia trachomatis and Neisseria gonorrhoeae: a review of the literature. Infect Dis Obstet Gynecol 2016; 2016: 5758387.
| Crossref | Google Scholar |
19 Patton ME, Kidd S, Llata E, Stenger M, Braxton J, Asbel L, et al. Extragenital gonorrhea and chlamydia testing and infection among men who have sex with men--STD Surveillance Network, United States, 2010-2012. Clin Infect Dis 2014; 58(11): 1564-1570.
| Crossref | Google Scholar | PubMed |
20 Chandra NL, Broad C, Folkard K, Town K, Harding-Esch EM, Woodhall SC, et al. Detection of Chlamydia trachomatis in rectal specimens in women and its association with anal intercourse: a systematic review and meta-analysis. Sex Transm Infect 2018; 94(5): 320-326.
| Crossref | Google Scholar | PubMed |
21 den Heijer CDJ, van Liere GAFS, Hoebe CJPA, van Bergen JEAM, Cals JWL, Stals FS, et al. Who tests whom? A comprehensive overview of Chlamydia trachomatis test practices in a Dutch region among different STI care providers for urogenital, anorectal and oropharyngeal sites in young people: a cross-sectional study. Sex Transm Infect 2016; 92(3): 211-217.
| Crossref | Google Scholar | PubMed |
22 New Zealand Parliament. Health (Protection) Amendment Act 2016, Schedule 1, Part 1, Section C—infectious diseases notifiable to medical officer of health without identifying information of patient or deceased person. 2016. Available at https://www.legislation.govt.nz/act/public/2016/0035/latest/DLM6223006.html [Accessed 14 June 2023]
23 Murray C, Rose SB, Kvalsvig A, Baker MG. Contact tracing for sexually transmitted infections in Aotearoa New Zealand: a review of clinician-notified gonorrhoea and syphilis data. J Prim Health Care 2023; 15(2): 167-171.
| Crossref | Google Scholar | PubMed |
25 World Health Organization. Regional Office for the Western Pacific. Review of national treatment guidelines for sexually transmitted infections in the Western Pacific Region [fact sheet]. License: CC BY-NC-SA 3.0 IGO. WHO Regional Office for the Western Pacific; 2018. Available at https://apps.who.int/iris/handle/10665/279732 [Accessed 14 June 2023]
