Journal articles: 'Pharyngeal gonorrhoea'

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Balachandran, T., A. P. Roberts, B. A. Evans, and B. S. Azadian. "Single-Dose Therapy of Anogenital and Pharyngeal Gonorrhoea with Ciprofloxacin." International Journal of STD & AIDS 3, no. 1 (January 1992): 49–51. http://dx.doi.org/10.1177/095646249200300112.

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A single dose of ciprofloxacin, 250 mg by mouth, was used in an open study to treat pharyngeal or rectal gonorrhoea or both in 64 patients (32 men and 32 women). The study also included 151 men with urethral gonorrhoea and 53 women with cervical or urethral gonorrhoea. Ciprofloxacin cured 63 (98%) patients with pharyngeal or rectal gonorrhoea (including 5 patients with penicillinase-producing Neisseria gonorrhoeae; PPNG), 147 (97%) men with urethral gonorrhoea (including 8 with PPNG) and 52 (98%) women with cervical or urethral gonorrhoea. All the isolates of N. gonorrhoeae were sensitive to 0.03 mg/l of ciprofloxacin. Five of the 6 patients with treatment failure were subsequently cured by a single oral dose of ciprofloxacin 250 mg. None of the patients reported an adverse reaction. Ciprofloxacin 250 mg as a single oral dose is effective and safe in treating patients with pharyngeal or rectal gonorrhoea, including those with PPNG strains.

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McMillan, A., H. Young, and A. Moyes. "Rectal Gonorrhoea in Homosexual Men: Source of Infection." International Journal of STD & AIDS 11, no. 5 (May 2000): 284–87. http://dx.doi.org/10.1177/095646240001100502.

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The objective of this retrospective study was to determine the possible source of infection in homosexual men with rectal gonorrhoea: the probable source of rectal gonorrhoea was identified in 46/155 cases. Although the urethra was the site of infection in 33 (72%) of these contacts, only pharyngeal gonorrhoea was identified in 9 (20%) men. In 25/26 cases, there was concordance in the auxo/serotypes of Neisseria gonorrhoeae between contacts with urethral gonorrhoea and the index men with rectal gonorrhoea. Eleven out of 12 pharyngeal isolates were of the same auxo/serotype as the index cases. This study supports the hypothesis that rectal gonorrhoea in homosexual men can be acquired from the oropharynx. Because infection at this site is an independent risk factor for acquisition of HIV, screening for rectal and pharyngeal gonorrhoea should be offered to men who have sex with men, even when there is no history of unprotected receptive anal intercourse.

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Marangoni, Antonella, Giacomo Marziali, Melissa Salvo, Antonietta D’Antuono, Valeria Gaspari, Claudio Foschi, and Maria Carla Re. "Mosaic structure of the penA gene in the oropharynx of men who have sex with men negative for gonorrhoea." International Journal of STD & AIDS 31, no. 3 (January 30, 2020): 230–35. http://dx.doi.org/10.1177/0956462419889265.

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The oropharynx represents a crucial site for the emergence of multi-drug resistance in Neisseria gonorrhoeae. The mosaic penA alleles, associated with decreased susceptibility to cephalosporins, have emerged by DNA recombination with partial penA genes, particularly those from commensal pharyngeal Neisseria species. Here, we investigated the prevalence of the mosaic structure of the penA gene in the oropharynx of men who have sex with men testing negative for pharyngeal gonorrhoea. From January 2016 to June 2018, 351 gonorrhoea-negative men who have sex with men attending a sexually transmitted infection clinic in Italy were enrolled. Pharyngeal swabs underwent a real-time polymerase chain reaction (PCR) for the detection of the mosaic penA gene. In case of positivity, PCR products were sequenced and searched against several sequences of Neisseria strains. Overall, 31 patients (8.8%) were found positive for the presence of the mosaic penA gene. The positivity was significantly associated with previous cases of pharyngeal gonorrhoea (relative risk [RR]: 3.56, 95% confidence interval 1.44–8.80) and with recent exposure to beta-lactams (RR: 4.29, 95% confidence interval 2.20–8.38). All penA-positive samples showed a high relatedness (90–99%) with mosaic-positive Neisseria strains. Our data underline that commensal Neisseria species of the oropharynx may be a significant reservoir for genetic material conferring antimicrobial resistance in N. gonorrhoeae.

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Richardson, Daniel, Alice Pickering, Daniel Trotman, Kayleigh Nichols, Zoe Buss, John Devlin, and Fionnuala Finnerty. "Pharyngeal gonorrhoea in men who have sex with men." International Journal of STD & AIDS 32, no. 5 (February 3, 2021): 449–52. http://dx.doi.org/10.1177/0956462420975627.

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Pharyngeal gonorrhoea is important in the transmission dynamics of gonorrhoea, and generation of antimicrobial resistance and the performing of culture remains vital. We reviewed the notes of men who have sex with men (MSM) presenting to our clinic with a positive pharyngeal NAAT for gonorrhoea between January and December 2019. There were 383 cases of NAAT-positive pharyngeal gonorrhoea, and 28 (7%, 95% CI = 5.11–10.36) reported sore throat at presentation. Pharyngeal cultures were taken from 270/383 (70%), and 73/270 (27%) were culture positive with available antimicrobial sensitivities. Overall, the presence of pharyngeal symptoms was not associated with pharyngeal chlamydia (OR = 1.6, CI = 0.19–13.32, p = 0.7), HIV status (OR = 1.1, CI = 0.47–2.57, p = 0.8), positive cultures (OR = 1.9, CI = 0.78–4.62, p = 0.2) or age ( p = 0.3). Routine screening of MSM for pharyngeal gonorrhoea is important to maintain surveillance and measures need to be taken to improve pharyngeal culture sampling from MSM.

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Kong, Fabian Y. S., Christina L. Hatzis, Andrew Lau, Deborah A. Williamson, Eric P. F. Chow, Christopher K. Fairley, and Jane S. Hocking. "Treatment efficacy for pharyngeal Neisseria gonorrhoeae: a systematic review and meta-analysis of randomized controlled trials." Journal of Antimicrobial Chemotherapy 75, no. 11 (August 3, 2020): 3109–19. http://dx.doi.org/10.1093/jac/dkaa300.

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Abstract Background Rising gonorrhoea rates require highly effective treatments to reduce transmission and prevent development of antimicrobial resistance. Currently the most effective treatments for pharyngeal gonorrhoea remain unclear. This review aimed to estimate treatment efficacy for pharyngeal gonorrhoea. Methods Online bibliographic databases were searched for the period 1 January 2000 to 17 September 2019 for treatments of gonorrhoea. All randomized controlled trials (RCTs) with data on pharyngeal gonorrhoea among participants aged 15 years or above, published in English, were included. Meta-analyses (random effects) were used to estimate the treatment efficacy, defined as microbiological cure, among currently recommended monotherapies and dual therapies, previously recommended but no longer used regimens and emerging drugs under evaluation. Side effects were also summarized. The study protocol was registered on PROSPERO (CRD42020149278). Results There were nine studies that included 452 participants studying 19 treatment regimens. The overall treatment efficacy for pharyngeal gonorrhoea was 98.1% (95% CI: 93.8%–100%; I2 = 57.3%; P < 0.01). Efficacy was similar for single (97.1%; 95% CI: 90.8%–100.0%; I2 = 15.6%; P = 0.29) and dual therapies (98.0%; 95% CI: 91.4%–100%; I2 = 79.1%; P < 0.01). Regimens containing azithromycin 2 g or ceftriaxone were similarly efficacious. The summary efficacy estimate for emerging drugs was 88.8% (95% CI: 76.9%–97.5%; I2 = 11.2%; P = 0.34). Small sample sizes in each trial was a major limitation. Conclusions Regimens containing ceftriaxone or azithromycin 2 g, alone or as part of dual therapies are the most efficacious for pharyngeal gonorrhoea. Further pharyngeal-specific RCTs with adequate sample sizes are needed.

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Janier, M., F. Lassau, I. Casin, and P. Morel. "Pharyngeal gonorrhoea: the forgotten reservoir." Sexually Transmitted Infections 79, no. 4 (August 1, 2003): 345. http://dx.doi.org/10.1136/sti.79.4.345.

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Lister, N. A., A. Smith, T. Read, and C. K. Fairley. "Testing men who have sex with men for Neisseria gonorrhoeae and Chlamydia trachomatis prior to the introduction of guidelines at an STD clinic in Melbourne." Sexual Health 1, no. 1 (2004): 47. http://dx.doi.org/10.1071/sh03005.

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Background: Guidelines for testing men who have sex with men (MSM) were published in 2002. They did not recommend asymptomatic screening for urethral gonorrhoea or pharyngeal screening for chlamydia. To determine if these guidelines were appropriate, we audited gonorrhoea and chlamydia testing of MSM at our centre. Methods: We carried out two audits at our Centre between August 2001 to July 2002. The first was an audit of testing MSM for gonorrhoea and/ or chlamydia over 12 days. The second was an audit of all positive tests over this 12-month period for gonorrhoea or chlamydia among MSM. Results: During the 12 selected days 89 of 286 men tested (31%) were MSM. Among the MSM testing positive for gonorrhoea and/ or chlamydia infection (15, 17%), symptomatic urethral infection was the most common (n = 8). No rectal and pharyngeal infections had site-specific symptoms. Based on the guidelines, 100 of the 334 tests ordered (30%) were not recommended according to the guidelines, and none of these 100 tests yielded a positive result. Over the 12-month audit period, 135 MSM were diagnosed with gonorrhoea and/ or chlamydia. For gonorrhoea, site specific symptoms were present in 42 of 43 cases of urethral infection (98%), six of 23 cases of rectal infection (26%), and no cases of pharyngeal infection had symptoms. For chlamydia, site-specific symptoms were present in 29 of 48 cases of urethral infection (60%), six of 33 cases of rectal infection (18%), and in one of the two cases of pharyngeal chlamydia identified. A substantial proportion of cases occurred in clients with HIV infection (21, 16%). Conclusions: These findings strongly support screening among MSM and in particular not testing asymptomatic MSM for urethral gonorrhoea or any MSM for pharyngeal Chlamydia.

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Barbee, Lindley A., and Matthew R. Golden. "Aztreonam for Neisseria gonorrhoeae: a systematic review and meta-analysis." Journal of Antimicrobial Chemotherapy 75, no. 7 (April 7, 2020): 1685–88. http://dx.doi.org/10.1093/jac/dkaa108.

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Abstract Background Ceftriaxone is the only consistently active antimicrobial agent recommended for the treatment of Neisseria gonorrhoeae. Although some new antimicrobials are in development, the necessity to expand treatment options in the near term may require using older drugs that have not been widely used to treat gonorrhoea. Methods We conducted a literature review of clinical trials and case series, published from 1983 to 2017, reporting treatment efficacy results following administration of 1 g aztreonam intramuscularly or IV for uncomplicated gonococcal infections. We summed trial data, stratified by anatomical site of infection, and calculated summary efficacy estimates and 95% CI for each site of infection. Results The 10 identified clinical trials enrolled 678, 38 and 16 individuals with urogenital, rectal and pharyngeal gonorrhoea, respectively. Aztreonam had an efficacy of 98.6% (95% CI: 97.5%–99.4%) for urogenital, 94.7% (95% CI: 82.3%–99.4%) for rectal and 81.3% (95% CI: 54.4%–96.0%) for pharyngeal gonococcal infections. Conclusions Although most clinical trials included in this meta-analysis were conducted >30 years ago, aztreonam appears to have excellent efficacy for urogenital gonorrhoea; its efficacy at extragenital sites remains uncertain.

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Comninos, Nicholas Byron, Linda Garton, Rebecca Guy, Denton Callander, Christopher K. Fairley, Andrew E. Grulich, Basil Donovan, Sian Louise Goddard, Alison Rutherford, and David J. Templeton. "Increases in pharyngeal Neisseria gonorrhoeae positivity in men who have sex with men, 2011–2015: observational study." Sexually Transmitted Infections 96, no. 6 (October 17, 2019): 432–35. http://dx.doi.org/10.1136/sextrans-2019-054107.

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ObjectivesPharyngeal gonorrhoea disproportionately affects men who have sex with men (MSM). We explored temporal trends in pharyngeal gonorrhoea positivity among MSM compared with anorectal and urogenital positivity.MethodsData (2011–2015) were extracted from 41 publicly funded sexual health clinics participating in a national surveillance network. Positivity was defined as the proportion of first-visit testing occasions where gonorrhoea was detected. Logistic regression explored trends in positivity and correlates of positive pharyngeal tests.ResultsFrom 2011 to 2015, 24 792 MSM tested (16 710 pharyngeal, 19 810 urogenital and 15 974 anorectal first-visit tests). Pharyngeal positivity increased by 183% from 139/3509 (4.0%) in 2011 to 397/3509 (11.3%) in 2015, p-trend <0.001; urogenital positivity by 39% from 257/4615 (5.6%) to 295/3783 (7.8%), p-trend=0.006; and anorectal positivity by 87% from 160/3469 (4.6%) to 286/3334 (8.6%), p-trend <0.001. The annual temporal increase in positivity was greater in the pharynx (OR 1.33; 95% CI 1.27 to 1.38) than at urogenital (OR 1.06; 95% CI 1.02 to 1.10) and anorectal (OR 1.16; 95% CI 1.11 to 1.21) sites. Factors independently associated with pharyngeal gonorrhoea were: younger age (p<0.001), higher numbers of recent sexual partners (p-trend=0.004), contact with a person with a diagnosed STI (p<0.001), injecting drug use (p<0.001), anogenital symptoms (p<0.001) and HIV-positive status (p=0.050).ConclusionTemporal increases in gonorrhoea positivity occurred at all anatomical sites, with the greatest increase in the pharynx. Risk factors could be used to help to develop testing and prevention strategies among MSM at highest risk. Strengthening sexual health service delivery, testing and surveillance remain priorities for pharyngeal gonorrhoea control.

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Tapsall, John, Phillip Read, Christopher Carmody, Christopher Bourne, Sanghamitra Ray, Athena Limnios, Theo Sloots, and David Whiley. "Two cases of failed ceftriaxone treatment in pharyngeal gonorrhoea verified by molecular microbiological methods." Journal of Medical Microbiology 58, no. 5 (May 1, 2009): 683–87. http://dx.doi.org/10.1099/jmm.0.007641-0.

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Diagnostic, genotypic and antibiotic-resistance determinants of Neisseria gonorrhoeae were analysed by molecular methods to verify the failure of ceftriaxone treatment in two cases of pharyngeal gonorrhoea. Monoplex assays were needed to define competitive inhibition of a positive Chlamydia PCR in a duplex assay. Different penA changes were detected in the N. gonorrhoeae isolated from the two cases. These were associated with raised ceftriaxone MICs of 0.03 and 0.016 mg l−1, which may have contributed to the treatment failures in these cases.

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Regan, David G., Ben B. Hui, James G. Wood, Helen Fifer, Monica M. Lahra, and David M. Whiley. "Treatment for pharyngeal gonorrhoea under threat." Lancet Infectious Diseases 18, no. 11 (November 2018): 1175–77. http://dx.doi.org/10.1016/s1473-3099(18)30610-8.

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Unemo, Magnus, Monica M. Lahra, Michelle Cole, Patricia Galarza, Francis Ndowa, Irene Martin, Jo-Anne R. Dillon, Pilar Ramon-Pardo, Gail Bolan, and Teodora Wi. "World Health Organization Global Gonococcal Antimicrobial Surveillance Program (WHO GASP): review of new data and evidence to inform international collaborative actions and research efforts." Sexual Health 16, no. 5 (2019): 412. http://dx.doi.org/10.1071/sh19023.

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Antimicrobial resistance (AMR) in Neisseria gonorrhoeae is a serious public health problem, compromising the management and control of gonorrhoea globally. Resistance in N. gonorrhoeae to ceftriaxone, the last option for first-line empirical monotherapy of gonorrhoea, has been reported from many countries globally, and sporadic failures to cure especially pharyngeal gonorrhoea with ceftriaxone monotherapy and dual antimicrobial therapies (ceftriaxone plus azithromycin or doxycycline) have been confirmed in several countries. In 2018, the first gonococcal isolates with ceftriaxone resistance plus high-level azithromycin resistance were identified in England and Australia. The World Health Organization (WHO) Global Gonococcal Antimicrobial Surveillance Program (GASP) is essential to monitor AMR trends, identify emerging AMR and provide evidence for refinements of treatment guidelines and public health policy globally. Herein we describe the WHO GASP data from 67 countries in 2015–16, confirmed gonorrhoea treatment failures with ceftriaxone with or without azithromycin or doxycycline, and international collaborative actions and research efforts essential for the effective management and control of gonorrhoea. In most countries, resistance to ciprofloxacin is exceedingly high, azithromycin resistance is present and decreased susceptibility or resistance to ceftriaxone has emerged. Enhanced global collaborative actions are crucial for the control of gonorrhoea, including improved prevention, early diagnosis, treatment of index patient and partner (including test-of-cure), improved and expanded AMR surveillance (including surveillance of antimicrobial use and treatment failures), increased knowledge of correct antimicrobial use and the pharmacokinetics and pharmacodynamics of antimicrobials and effective drug regulations and prescription policies (including antimicrobial stewardship). Ultimately, rapid, accurate and affordable point-of-care diagnostic tests (ideally also predicting AMR and/or susceptibility), new therapeutic antimicrobials and, the only sustainable solution, gonococcal vaccine(s) are imperative.

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Kinghorn, G. "Pharyngeal gonorrhoea: a silent cause for concern." Sexually Transmitted Infections 86, no. 6 (August 26, 2010): 413–14. http://dx.doi.org/10.1136/sti.2010.043349.

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Lusk, M. Josephine, Ruby N. N. Uddin, Monica M. Lahra, Frances L. Garden, Ratan L. Kundu, and Pam Konecny. "Pharyngeal Gonorrhoea in Women: An Important Reservoir for Increasing Neisseria gonorrhoea Prevalence in Urban Australian Heterosexuals?" Journal of Sexually Transmitted Diseases 2013 (June 26, 2013): 1–5. http://dx.doi.org/10.1155/2013/967471.

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We aim to characterize sexual behavioral aspects of heterosexual Neisseria gonorrhoea (NG) acquisition in two Sexually Transmitted Diseases clinics in Sydney, Australia, in 2008–2012. Of 167 NG cases, 102 were heterosexually acquired with a trend of increasing NG prevalence in heterosexuals from 1.1% (95% CI 0.6–2.1) in 2008 to 3.0% (95% CI 2.0–4.0) in 2012 (P=0.027). Of heterosexual male cases, unprotected fellatio was the likely sexual activity for NG acquisition in 21/69 (30.4%) and commercial sex work (CSW) contact the likely source in 28/69 (40.6%). NG prevalence overall in CSW (2.2%) was not significantly higher than in non-CSW (1.2%) (P=0.15), but in 2012 there was a significant increase in NG prevalence in CSW (8.6%) compared to non-CSW (1.6%) (P<0.001). Pharyngeal NG was found in 9/33 (27.3%) female cases. Decreased susceptibility to ceftriaxone (MIC ≥ 0.03 mg/L) occurred in 2.5% NG isolates, none heterosexually acquired. All were azithromycin susceptible. A significant trend of increasing prevalence of heterosexual gonorrhoea in an urban Australian STD clinic setting is reported. We advocate maintenance of NG screening in women, including pharyngeal screening in all women with partner change who report fellatio, as pharyngeal NG may be an important reservoir for heterosexual transmission. Outreach to CSW should be enhanced.

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Chow, Eric P. F., Shayne Camilleri, Christopher Ward, Sarah Huffam, Marcus Y. Chen, Catriona S. Bradshaw, and Christopher K. Fairley. "Duration of gonorrhoea and chlamydia infection at the pharynx and rectum among men who have sex with men: a systematic review." Sexual Health 13, no. 3 (2016): 199. http://dx.doi.org/10.1071/sh15175.

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Background Chlamydia and gonorrhoea are the two most common sexually transmissible infections (STI) among men who have sex with men (MSM) worldwide. Infections at the pharynx and rectum are usually asymptomatic; however, the natural history of these infections remains unknown. The aim of this study is to estimate the duration of both infections at the extragenital sites from published epidemiological cohort studies. Methods: English peer-reviewed articles were searched from 1 January 2000 to 12 March 2015 in three electronic databases (MEDLINE, EMBASE and Cochrane Central). The prevalence-to-incidence ratio from each study was calculated to reflect the duration of each infection. This review followed the PRISMA guidelines and was registered in PROSPERO (CRD42014007087). Results: There were 2585 records identified, with 1721 abstracts and 52 full-text articles screened, resulting in four studies fulfilling the inclusion criteria. Pharyngeal gonorrhoea (114–138 days) had a shorter duration of infection than rectal gonorrhoea (346 days). In addition, chlamydia had a longer duration of infection at the pharynx (667 days) and rectum (579 days) compared with gonorrhoea infection. Conclusions: Gonorrhoea has a shorter duration of infection than chlamydia, suggesting that annual STI screening will be more effective at diagnosing chlamydia than gonorrhoea. The current STI guidelines recommend screening gonorrhoea and chlamydia at least once a year in MSM; it would only detect ~30% of incident pharyngeal gonorrhoea cases, with a mean duration of 4 months.

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Cornelisse, Vincent J., Christopher K. Fairley, Sandra Walker, Tameka Young, David Lee, Marcus Y. Chen, Catriona S. Bradshaw, and Eric P. F. Chow. "Adherence to, and acceptability of, Listerine® mouthwash as a potential preventive intervention for pharyngeal gonorrhoea among men who have sex with men in Australia: a longitudinal study." Sexual Health 13, no. 5 (2016): 494. http://dx.doi.org/10.1071/sh16026.

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We investigated whether men who have sex with men (MSM) would use mouthwash daily to prevent pharyngeal gonorrhoea. Ten MSM attending the Melbourne Sexual Health Centre were asked to use a Listerine® alcohol-containing mouthwash daily for 14 days in August 2015. Mouthwash was used at least once daily for 133 of 140 person-days (95% of days; 95% confidence interval 90–98%). All 10 men were willing to use mouthwash on a daily basis, and nine men were willing to use mouthwash after oral sex. This study showed that daily use of mouthwash is an acceptable intervention to prevent pharyngeal gonorrhoea in MSM.

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Templeton, David J., Phillip Read, Rajesh Varma, and Christopher Bourne. "Australian sexually transmissible infection and HIV testing guidelines for asymptomatic men who have sex with men 2014: a review of the evidence." Sexual Health 11, no. 3 (2014): 217. http://dx.doi.org/10.1071/sh14003.

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Men who have sex with men (MSM) in Australia and overseas are disproportionately affected by sexually transmissible infections (STIs), including HIV. Many STIs are asymptomatic, so regular testing and management of asymptomatic MSM remains an important component of effective control. We reviewed articles from January 2009–May 2013 to inform the 2014 update of the 2010 Australian testing guidelines for asymptomatic MSM. Key changes include: a recommendation for pharyngeal chlamydia (Chlamydia trachomatis) testing, use of nucleic acid amplification tests alone for gonorrhoea (Neisseria gonorrhoeae) testing (without gonococcal culture), more frequent (up to four times a year) gonorrhoea and chlamydia testing in sexually active HIV-positive MSM, time required since last void for chlamydia first-void urine collection specified at 20 min, urethral meatal swab as an alternative to first-void urine for urethral chlamydia testing, and the use of electronic reminders to increase STI and HIV retesting rates among MSM.

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Sathia, Leena, Ben Ellis, Stuart Phillip, Alan Winston, and Alan Smith. "Pharyngeal gonorrhoea – is dual therapy the way forward?" International Journal of STD & AIDS 18, no. 9 (September 1, 2007): 647–48. http://dx.doi.org/10.1258/095646207781568556.

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Lister, Nichole A., Anthony Smith, and Christopher K. Fairley. "Introduction of screening guidelines for men who have sex with men at an STD clinic, the Melbourne Sexual Health Centre, Australia." Sexual Health 2, no. 4 (2005): 241. http://dx.doi.org/10.1071/sh05006.

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Background: A recent audit indicated that a substantial proportion of men who have sex with men (MSM) were not screened for rectal gonorrhoea and chlamydia at the Melbourne Sexual Health Clinic, Melbourne, Australia. In response, screening guidelines for MSM were introduced at the clinic using a computer reminder. The aim of this study was to evaluate the impact of the guidelines and alert on screening MSM for gonorrhoea and chlamydia. Methods: The medical records of MSM were reviewed for gonorrhoea and chlamydia screening by site (pharyngeal, urethral and rectal), four months before the implementation of the guidelines and alert (July to October 2002), and one year thereafter (beginning November 2002). Results: After the introduction of the guidelines there was a significant increase in rectal chlamydia testing (55% to 67%, P < 0.001), and significant reduction in pharyngeal chlamydia and gonorrhoea testing (65% to 28%, P < 0.001, and 83% to 76%, P = 0.015 respectively). The proportion of tests that were positive by any site did not change (7% to 7%). Conclusions: The introduction of a computer reminder for new guidelines was temporally associated with screening that conformed more closely to clinical guidelines.

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Rajagopal, Preethi, Sian L. Goddard, and David J. Templeton. "Substantial increase in yield of Neisseria gonorrhoeae testing 2008–2013 at a Sydney metropolitan sexual health clinic: an observational study." Sexual Health 15, no. 1 (2018): 79. http://dx.doi.org/10.1071/sh17080.

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Background A substantial increase in gonorrhoea notifications in New South Wales has been observed in recent years. Methods: We assessed yield of testing and characteristics of those diagnosed with gonorrhoea from January 2008 to December 2013 at RPA Sexual Health in the inner-west of Sydney. Yield was defined as the proportion of testing occasions which were positive for gonorrhoea. Generalised estimating equations were used to calculate trends in yield over time. Results: During the 6-year study period, 6456 individuals (4308 males, 2124 females, 24 transgender individuals) were tested on 12 799 occasions; this included 2441 gay and bisexual men (GBM) who were tested on 6945 occasions. Over the study period there was a significant increase in testing at genital, anorectal and pharyngeal sites (P-trend <0.001 for all). In total, gonorrhoea was detected on 668 testing occasions among 536 individuals (5.2%). Overall, 254/12765 (2.0%) of genital tests, 251/7326 (3.4%) of anorectal tests and 342/8252 (4.1%) of pharyngeal tests were positive. There was a significant increase in overall gonorrhoea yield from 2.2% in 2008 to 7.1% in 2013 (P-trend <0.001). This temporal increase in gonorrhoea yield was observed in heterosexual males (P < 0.001), heterosexual females (P-trend = 0.008), female sex workers (P-trend = 0.006), HIV-positive GBM and HIV-negative GBM (both P < 0.001) and at all anatomical sites (P-trend <0.001 for all). Conclusions: From 2008 to 2013, we observed a greater than threefold increase in yield of gonorrhoea testing disproportionately affecting GBM, although the increase also occurred in other subpopulations and at all anatomic sites. More frequent and comprehensive testing could potentially reduce the high and increasing community prevalence of gonorrhoea.

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Maddaford, Kate, Christopher K. Fairley, Sabrina Trumpour, Mark Chung, and Eric P. F. Chow. "Sites in the oropharynx reached by different methods of using mouthwash: clinical implication for oropharyngeal gonorrhoea prevention." Sexually Transmitted Infections 96, no. 5 (October 18, 2019): 358–60. http://dx.doi.org/10.1136/sextrans-2019-054158.

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ObjectivesOropharyngeal gonorrhoea is increasing among men who have sex with men and is commonly found in the tonsils and at the posterior pharyngeal wall. To address this rise, investigators are currently trialling mouthwash to prevent oropharyngeal gonorrhoea. We aimed to determine which parts of the oropharynx were reached by different methods of mouthwash use (oral rinse, oral gargle and oral spray).MethodsTwenty staff at Melbourne Sexual Health Centre participated in the study from March to May 2018. Participants were asked to use mouthwash mixed with food dye, by three application methods on three separate days: oral rinse (15 s and 60 s), oral gargle (15 s and 60 s) and oral spray (10 and 20 times). Photographs were taken after using each method. Three authors assessed the photographs of seven anatomical areas (tongue base, soft palate, uvula, anterior tonsillar pillar, posterior tonsillar pillar, tonsil, posterior pharyngeal wall) independently and scored the dye coverage from 0% to 100%. Scores were then averaged.ResultsThe mean coverage at the sites ranged from 2 to 100. At the posterior pharyngeal wall, spraying 10 times had the highest mean coverage (29%) and was higher than a 15 s rinse (2%, p=0.001) or a 15 s gargle (8%, p=0.016). At the tonsils, there was no difference in mean coverage between spray and gargle at any dosage, but spraying 20 times had a higher mean coverage than a 15 s rinse (42% vs 12%, p=0.012).ConclusionOverall, spray is more effective at reaching the tonsils and posterior pharyngeal wall compared with rinse and gargle. If mouthwash is effective in preventing oropharyngeal gonorrhoea, application methods that have greater coverage may be more efficacious.

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Linhart, Y., T. Shohat, Z. Amitai, D. Gefen, I. Srugo, G. Blumstein, and M. Dan. "Sexually transmitted infections among brothel-based sex workers in Tel-Aviv area, Israel: high prevalence of pharyngeal gonorrhoea." International Journal of STD & AIDS 19, no. 10 (October 2008): 656–59. http://dx.doi.org/10.1258/ijsa.2008.008127.

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Sex workers play a major role in spreading sexually transmitted infections (STIs). We studied the prevalence rates and risk factors for STIs among 300 brothel-based sex workers in Tel-Aviv. Throat swabs were cultured for Neisseria gonorrhoeae, urine samples were tested by polymerase chain reaction (PCR) for Chlamydia trachomatis and N. gonorrhoeae, and sera were tested for syphilis, human immunodeficiency virus (HIV) and type 2 herpes simplex virus (HSV) antibodies. N. gonorrhoeae was cultured from throat samples of 9.0% of participants; PCR testing of urine was positive for C. trachomatis in 6.3% and for N. gonorrhoeae in 5.0%. Syphilis serology was positive (Venereal Disease Research Laboratory [VDRL] titres >1:8) in 1.3% of women, HSV-2-specific immunoglobulin G was detected in 60% and HIV serology was positive in a single case (0.3%). Having STI was significantly associated with age, number of years in Israel, number of clients a week and condom use for vaginal sex. In a multivariate analysis, having STI was significantly associated with number of clients per week and condom use for vaginal sex. The high prevalence of pharyngeal gonorrhoea reflects most probably the expanding demand of clients for oral sex and the insufficient condom use in this form of sex.

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Christophersen, J., A. C. Bollerup, E. From, J. O. Ronne-Rasmussen, and K. Quitzau. "Treating genitourinary and pharyngeal gonorrhoea with single dose ceftriaxone." Sexually Transmitted Infections 65, no. 1 (January 1, 1989): 14–17. http://dx.doi.org/10.1136/sti.65.1.14.

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Sulaiman, M. Z., C. M. Bates, J. B. Bittiner, C. A. Dixon, and R. C. Slack. "Response of pharyngeal gonorrhoea to single dose penicillin treatment." Sexually Transmitted Infections 63, no. 2 (April 1, 1987): 92–94. http://dx.doi.org/10.1136/sti.63.2.92.

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David, L. M. "Acquisition of pharyngeal gonorrhoea via sweets passed by mouth." Sexually Transmitted Infections 73, no. 2 (April 1, 1997): 146. http://dx.doi.org/10.1136/sti.73.2.146.

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Ross, J. D. C., A. McMillan, and H. young. "Changing trends of gonococcal infection in homosexual men in Edinburgh." Epidemiology and Infection 107, no. 3 (December 1991): 585–90. http://dx.doi.org/10.1017/s0950268800049281.

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SUMMARYIn an attempt to explain the recent resurgence of homosexually-acquired gonorrhoea in the Lothian region of Scotland the number of infections and pattern of infection (urethral, rectal and pharyngeal) of all gonococcal isolates from homosexual men attending the Department of Genitourinary Medicine at Edinburgh Royal Infirmary between 1985 and 1990 were analysed. Serovar typing data were available from infections acquired between January 1986 and December 1990. A correlation between one serovar, Bacejk/Brpyust, and the overall pattern of gonorrhoea was observed. The number of infections caused by minor serovars also correlated with rates of gonococcal infection. The number of minor serovars isolated, which may represent strains from other geographical locations, is related to the total incidence of gonorrhoea. It is possible that the incidence of Bacejk/Brpyust may be determined by the size of the infected pool of gonorrhoea. The most likely explanation for the recent increase in gonorrhoea is a change in sexual behaviour and/or an influx of strains from other geographical areas.

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Wardropper, A. G., and R. S. Pattman. "Gonorrhoea as an Indicator of Altered Sexual Behaviour and as a Surrogate Marker of HIV Concern: A 13-Year Analysis in Newcastle." International Journal of STD & AIDS 6, no. 5 (September 1995): 348–50. http://dx.doi.org/10.1177/095646249500600508.

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Summary: It has been proposed that changes in sexual behaviour arising out of concerns regarding HIV infection can be inferred by changes in the incidence of gonorrhoea. We have reviewed data on gonococcal isolates in Newcastle over the last 13 years and looked at changes in relation to HIV test requests, new cases of HIV infection and media campaigns. HIV testing has been available in the clinic since late 1985. There was a steady decline in cases of gonorrhoea from 1985–1991 and then as in other areas an increase in incidence was seen among homosexual and bisexual men. The majority of this recent increase was due to pharyngeal infection. Sexual behaviour may have changed but this cannot be purely attributed to HIV concerns. HIV testing began after the incidence of gonorrhoea in England was already falling and we found no relationship between trends in gonorrhoea, HIV test requests and new cases of HIV infection.

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Mitchell, M., V. Rane, C. K. Fairley, D. M. Whiley, C. S. Bradshaw, M. Bissessor, and M. Y. Chen. "Sampling technique is important for optimal isolation of pharyngeal gonorrhoea." Sexually Transmitted Infections 89, no. 7 (May 21, 2013): 557–60. http://dx.doi.org/10.1136/sextrans-2013-051077.

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Wardropper, A., and R. S. Pattman. "Single Dose Therapy of Anogenital and Pharyngeal Gonorrhoea with Ciprofloxacin." International Journal of STD & AIDS 3, no. 5 (September 1992): 372. http://dx.doi.org/10.1177/095646249200300518.

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Hananta, IPY, MF Schim van der Loeff, AP van Dam, H. Soebono, and HJC de Vries. "P05.06 Prolonged infection of pharyngeal gonorrhoea after treatment with ceftriaxone." Sexually Transmitted Infections 91, Suppl 2 (September 2015): A110.1—A110. http://dx.doi.org/10.1136/sextrans-2015-052270.292.

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Ross, Jonathan DC, Jan Harding, Lelia Duley, Alan A. Montgomery, Trish Hepburn, Wei Tan, Clare Brittain, et al. "Gentamicin as an alternative to ceftriaxone in the treatment of gonorrhoea: the G-TOG non-inferiority RCT." Health Technology Assessment 23, no. 20 (May 2019): 1–104. http://dx.doi.org/10.3310/hta23200.

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Background Gonorrhoea is a common sexually transmitted infection that can cause pain and discomfort, affect fertility in women and lead to epididymo-orchitis in men. Current treatment is with ceftriaxone, but there is increasing evidence of antimicrobial resistance reducing its effectiveness. Gentamicin is a potential alternative treatment requiring further evaluation. Objectives To assess the clinical effectiveness and cost-effectiveness of gentamicin as an alternative treatment to ceftriaxone in the treatment of gonorrhoea. Design A multicentre, parallel-group, blinded, non-inferiority randomised controlled trial. Setting Fourteen sexual health clinics in England. Participants Adults aged 16–70 years with a diagnosis of uncomplicated, untreated genital, pharyngeal or rectal gonorrhoea based on a positive Gram-stained smear on microscopy or a positive nucleic acid amplification test (NAAT). Randomisation and blinding Participants were randomised using a secure web-based system, stratified by clinic. Participants, investigators and research staff assessing participants were blinded to treatment allocation. Interventions Allocation was to either 240 mg of gentamicin (intervention) or 500 mg of ceftriaxone (standard treatment), both administered as a single intramuscular injection. All participants also received 1 g of oral azithromycin. Main outcome measure The primary outcome measure was clearance of Neisseria gonorrhoeae at all infected sites, confirmed by a negative Aptima Combo 2® (Hologic Inc., Marlborough, MA, USA) NAAT, at 2 weeks post treatment. Results We randomised 720 participants, of whom 81% were men. There were 358 participants in the gentamicin group and 362 in the ceftriaxone group; 292 (82%) and 306 (85%) participants, respectively, were included in the primary analysis. Non-inferiority of gentamicin to ceftriaxone could not be demonstrated [adjusted risk difference for microbiological clearance –6.4%, 95% confidence interval (CI) –10.4% to –2.4%]. Clearance of genital infection was similar in the two groups, at 94% in the gentamicin group and 98% in the ceftriaxone group, but clearance of pharyngeal infection and rectal infection was lower in the gentamicin group (80% vs. 96% and 90% vs. 98%, respectively). Reported pain at the injection site was higher for gentamicin than for ceftriaxone. The side-effect profiles were comparable between the groups. Only one serious adverse event was reported and this was deemed not to be related to the trial medication. The economic analysis found that treatment with gentamicin is not cost neutral compared with standard care, with average patient treatment costs higher for those allocated to gentamicin (£13.90, 95% CI £2.47 to £37.34) than to ceftriaxone (£6.72, 95% CI £1.36 to £17.84). Limitations Loss to follow-up was 17% but was similar in both treatment arms. Twelve per cent of participants had a negative NAAT for gonorrhoea at their baseline visit but this was balanced between treatment groups and unlikely to have biased the trial results. Conclusions The trial was unable to demonstrate non-inferiority of gentamicin compared with ceftriaxone in the clearance of gonorrhoea at all infected sites. Clearance at pharyngeal and rectal sites was lower for participants allocated to gentamicin than for those allocated to ceftriaxone, but was similar for genital sites in both groups. Gentamicin was associated with more severe injection site pain. However, both gentamicin and ceftriaxone appeared to be well tolerated. Future work Exploration of the genetic determinants of antibiotic resistance in N. gonorrhoeae will help to identify accurate markers of decreased susceptibility. Greater understanding of the immune response to infection can assist gonococcal vaccine development. Trial registration Current Controlled Trials ISRCTN51783227. Funding This project was funded by the National Institute for Health Research Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 20. See the NIHR Journals Library website for further project information.

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Unemo, Magnus, Josefine Ahlstrand, Leonor Sánchez-Busó, Michaela Day, David Aanensen, Daniel Golparian, Susanne Jacobsson, et al. "High susceptibility to zoliflodacin and conserved target (GyrB) for zoliflodacin among 1209 consecutive clinical Neisseria gonorrhoeae isolates from 25 European countries, 2018." Journal of Antimicrobial Chemotherapy 76, no. 5 (February 10, 2021): 1221–28. http://dx.doi.org/10.1093/jac/dkab024.

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Abstract Objectives Novel antimicrobials for treatment of gonorrhoea are imperative. The first-in-class spiropyrimidinetrione zoliflodacin is promising and currently in an international Phase 3 randomized controlled clinical trial (RCT) for treatment of uncomplicated gonorrhoea. We evaluated the in vitro activity of and the genetic conservation of the target (GyrB) and other potential zoliflodacin resistance determinants among 1209 consecutive clinical Neisseria gonorrhoeae isolates obtained from 25 EU/European Economic Area (EEA) countries in 2018 and compared the activity of zoliflodacin with that of therapeutic antimicrobials currently used. Methods MICs of zoliflodacin, ceftriaxone, cefixime, azithromycin and ciprofloxacin were determined using an agar dilution technique for zoliflodacin or using MIC gradient strip tests or an agar dilution technique for the other antimicrobials. Genome sequences were available for 96.1% of isolates. Results Zoliflodacin modal MIC, MIC50, MIC90 and MIC range were 0.125, 0.125, 0.125 and ≤0.004–0.5 mg/L, respectively. The resistance was 49.9%, 6.7%, 1.6% and 0.2% to ciprofloxacin, azithromycin, cefixime and ceftriaxone, respectively. Zoliflodacin did not show any cross-resistance to other tested antimicrobials. GyrB was highly conserved and no zoliflodacin gyrB resistance mutations were found. No fluoroquinolone target GyrA or ParC resistance mutations or mutations causing overexpression of the MtrCDE efflux pump substantially affected the MICs of zoliflodacin. Conclusions The in vitro susceptibility to zoliflodacin was high and the zoliflodacin target GyrB was conserved among EU/EEA gonococcal isolates in 2018. This study supports further clinical development of zoliflodacin. However, additional zoliflodacin data regarding particularly the treatment of pharyngeal gonorrhoea, pharmacokinetics/pharmacodynamics and resistance selection, including suppression, would be valuable.

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Jasper, William, Madeleine Macdonald, Danayan Luxmanan, Elizabeth Foley, and Rajul Patel. "Telephone-triage services do not lead to an increased wait time for assessment of gonorrhoea in symptomatic patients." International Journal of STD & AIDS 32, no. 9 (May 5, 2021): 852–55. http://dx.doi.org/10.1177/0956462421999280.

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In Spring 2017, Southampton and Portsmouth Sexual Health Services (SHSs) replaced an overstretched walk-in service with a telephone-triage service: patients calling that were symptomatic, vulnerable or at high risk of having an STI were invited into a clinic, whereas others were signposted to remote self-sample NHS postal testing services. This study aimed to establish whether patient care was disadvantaged by the introduction of the triage service. Electronic patient notes for all patients attending for treatment of gonorrhoea for two years before and for two years after the service change were interrogated; the site of infection and duration of symptoms before testing were compared. Of all patients attending for treatment of gonorrhoea in the study period, 499 patients (39% of cases) were symptomatic at testing: 364 had urethral symptoms, 45 had rectal symptoms and 18 had pharyngeal symptoms. 72.4% of patients with urethral symptoms were seen after the introduction of the triage system. Median wait times for patients with urethral symptoms rose from 6 (IQR = 3–7) to 7 (IQR = 3.75–14) days – although this increase was not statistically significant ( p = 0.064). There was not a statistically significant difference between the rectal symptom groups ( p = 0.422) and too few patients attended with pharyngeal symptoms to warrant analysis. Despite some outliers, the telephone-triage service did not increase wait times for patients attending STI services with symptomatic gonorrhoea and may have inadvertently increased access to services for those most at risk.

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Bennett, Amy, Katie Jeffery, Eunan O’Neill, and Jackie Sherrard. "Outbreak or illusion: consequences of ‘improved’ diagnostics for gonorrhoea." International Journal of STD & AIDS 28, no. 7 (July 12, 2016): 667–71. http://dx.doi.org/10.1177/0956462416660928.

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The sexual health service in Oxford introduced gonorrhoea nucleic amplification acid testing using the BD Viper XTR™ System. For practical reasons, a confirmatory nucleic amplification acid testing using a different platform was not used initially. Following the introduction of nucleic amplification acid testing, the rates of gonorrhoea increased threefold. Concerns were raised that this increase represented an outbreak. A retrospective review of cases over six months suggested that there may have been a number of false-positive results. A prospective study was then undertaken over six months, where all gonorrhoea positive samples were sent for confirmatory testing. This evaluation of all gonorrhoea cases in an English county found that the overall presumptive false-positive rates for gonorrhoea nucleic amplification acid testing using BD Viper XTR™ in our population are significant at 27% of female samples, 13.2% of heterosexual male samples, 3.5% of anogenital multiple site men who have sex with men samples and 62.8% of pharyngeal only men who have sex with men samples. The data demonstrate the need for confirmatory testing using a second nucleic acid target, as per BASHH/Public Health England guidelines, especially in low-prevalence settings and extragenital sites, due to cross-reactivity with commensal Neisseria species and low positive predictive values.

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Koedijk, F. D. H., J. E. A. M. van Bergen, N. H. T. M. Dukers-Muijrers, A. P. van Leeuwen, C. J. P. A. Hoebe, and M. A. B. van der Sande. "The value of testing multiple anatomic sites for gonorrhoea and chlamydia in sexually transmitted infection centres in the Netherlands, 2006–2010." International Journal of STD & AIDS 23, no. 9 (September 2012): 626–31. http://dx.doi.org/10.1258/ijsa.2012.011378.

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National surveillance data from 2006 to 2010 of the Dutch sexually transmitted infection (STI) centres were used to analyse current practices on testing extragenital sites for chlamydia and gonorrhoea in men who have sex with men (MSM) and women. In MSM, 76.0% and 88.9% were tested at least at one extragenital site (pharyngeal and/or anorectal) for chlamydia and gonorrhoea, respectively; for women this was 20.5% and 30.2%. Testing more than one anatomic site differed by STI centre, ranging from 2% to 100%. In MSM tested at multiple sites, 63.0% and 66.5% of chlamydia and gonorrhoea diagnoses, respectively, would have been missed if screened at the urogenital site only, mainly anorectal infections. For women tested at multiple sites, the proportions of missed chlamydia and gonorrhoea diagnoses would have been 12.9% and 30.0%, respectively. Testing extragenital sites appears warranted, due to the numerous infections that would have been missed. Adding anorectal screening to urogenital screening for all MSM visiting an STI centre should be recommended. Since actual testing practices differ by centre, there is a need for clearer guidelines. Routine gonorrhoea and chlamydia screening at multiple sites in STI centres should be investigated further as this might be a more effective approach to reduce transmission than current practice.

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Read, P. J., H. Wand, R. Guy, A. McNulty, and B. Donovan. "P1-S2.19 Unprotected fellatio and pharyngeal gonorrhoea in Sydney sex workers." Sexually Transmitted Infections 87, Suppl 1 (July 1, 2011): A130—A131. http://dx.doi.org/10.1136/sextrans-2011-050108.76.

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Y. Chen, M., K. Stevens, R. Tideman, A. Zaia, T. Tomita, C. K. Fairley, M. Lahra, D. Whiley, and G. Hogg. "Failure of 500 mg of ceftriaxone to eradicate pharyngeal gonorrhoea, Australia." Journal of Antimicrobial Chemotherapy 68, no. 6 (February 6, 2013): 1445–47. http://dx.doi.org/10.1093/jac/dkt017.

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Wardropper, A., and R. S. Pattman. "An increase in pharyngeal gonorrhoea: cause for concern regarding HIV infection." Sexually Transmitted Infections 68, no. 5 (October 1, 1992): 343–44. http://dx.doi.org/10.1136/sti.68.5.343.

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Mitchell, M., V. Rane, C. K. Fairley, D. M. Whiley, C. S. Bradshaw, M. Bissessor, and M. Y. Chen. "P2.034 Sampling Technique is Important For Optimal Isolation of Pharyngeal Gonorrhoea." Sexually Transmitted Infections 89, Suppl 1 (July 2013): A98.1—A98. http://dx.doi.org/10.1136/sextrans-2013-051184.0299.

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Fairley, Christopher K., Marcus Y. Chen, Catriona S. Bradshaw, and Sepehr N. Tabrizi. "Is it time to move to nucleic acid amplification tests screening for pharyngeal and rectal gonorrhoea in men who have sex with men to improve gonorrhoea control?" Sexual Health 8, no. 1 (2011): 9. http://dx.doi.org/10.1071/sh10134.

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The use of nucleic acid amplification tests (NAAT), as well as or in preference to culture for non-genital sites is now recommended both in Australia and overseas because of their greater sensitivity and improved specificity. A survey of 22 Australian sexual health clinics who each year test over 14 500 men who have sex with men (MSM) show that culture remains the predominate method for detecting gonorrhoea at pharyngeal (64%) and rectal (73%) sites. This editorial discusses the potential disadvantages of using culture over NAAT in relation to optimal gonorrhoea control among MSM and advocates that significantly improved control would be achieved by moving to NAAT with the proviso that culture samples are taken wherever possible on NAAT-positive samples and from clients with urethritis to ensure continued surveillance for antimicrobial resistance.

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&NA;. "Single-dose oral azithromycin 2g is highly effective in treating pharyngeal gonorrhoea,." Inpharma Weekly &NA;, no. 1553 (September 2006): 15. http://dx.doi.org/10.2165/00128413-200615530-00037.

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McMillan, A., and H. Young. "The treatment of pharyngeal gonorrhoea with a single oral dose of cefixime." International Journal of STD & AIDS 18, no. 4 (April 2007): 253–54. http://dx.doi.org/10.1258/095646207780658971.

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Latimer, Rosie Louise, Lenka Vodstrcil, Vesna De Petra, Christopher K. Fairley, Tim RH Read, Deborah Williamson, Michelle Doyle, Eric PF Chow, and Catriona Bradshaw. "Extragenital Mycoplasma genitalium infections among men who have sex with men." Sexually Transmitted Infections 96, no. 1 (June 19, 2019): 10–18. http://dx.doi.org/10.1136/sextrans-2019-054058.

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ObjectivesThere are limited data on the prevalence of Mycoplasma genitalium (Mgen) coinfection with rectal chlamydia (Chlamydia trachomatis (CT)) and rectal gonorrhoea (Neisseria gonorrhoeae (NG)) infections and few studies examining the prevalence of pharyngeal Mgen in men who have sex with men (MSM). Using transcription-mediated amplification assay, this study aimed to determine the proportion of rectal CT and rectal NG infections in MSM who are coinfected with rectal Mgen, and the proportion of MSM with Mgen detected in the pharynx in order to inform clinical practice.MethodsThis was a cross-sectional study conducted at Melbourne Sexual Health Centre in Australia. Consecutively collected rectal swabs from MSM that tested positive for CT (n=212) or NG (n=212), and consecutively collected pharyngeal samples (n=480) from MSM were tested for Mgen using the Aptima Mycoplasma genitalium Assay (Hologic, San Diego). Samples were linked to demographic data and symptom status.ResultsRectal Mgen was codetected in 27 of 212 rectal CT (13%, 95% CI 9 to 18) and in 29 of 212 rectal NG (14%, 95% CI 9 to 19) samples, with no difference in the proportion positive for Mgen. MSM with rectal CT/Mgen coinfection had more sexual partners than those with rectal CT monoinfection (mean 6 vs 11, p=0.06). MSM with rectal NG/Mgen coinfection were more likely to be HIV-positive than those with rectal NG monoinfection (OR=2.96, 95% CI 1.21 to 7.26, p=0.023). MSM with rectal CT/Mgen coinfection were more likely to be using pre-exposure prophylaxis than MSM with rectal NG/Mgen coinfection (OR 0.25, 95% CI 0.10 to 0.65, p=0.002). Pharyngeal Mgen was uncommon and detected in 8 of 464 samples (2%, 95% CI 1% to 3%). Pharyngeal Mgen was associated with having a rectal STI (OR=10.61, 95% CI 2.30 to 48.87, p=0.002), and there was a borderline association with being HIV-positive (p=0.079).ConclusionThese data indicate one in seven MSM treated for rectal CT or rectal NG will have undiagnosed Mgen that is potentially exposed to azithromycin during treatment of these STIs. Rectal Mgen coinfection was associated with specific risk factors which may inform testing practices. Pharyngeal Mgen was uncommon.

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Bakhtiar, M., and P. L. Samarasinghe. "Enoxacin as one day oral treatment of men with anal or pharyngeal gonorrhoea." Sexually Transmitted Infections 64, no. 6 (December 1, 1988): 364–66. http://dx.doi.org/10.1136/sti.64.6.364.

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COKER, D. M., I. AHMED-JUSHUF, O. P. ARYA, J. S. CHESSBROUGH, and B. C. PRATT. "Evaluation of single dose dprofloxadn in the treatment of rectal and pharyngeal gonorrhoea." Journal of Antimicrobial Chemotherapy 24, no. 2 (1989): 271–72. http://dx.doi.org/10.1093/jac/24.2.271.

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Hiransuthikul, Akarin, Rena Janamnuaysook, Thanthip Sungsing, Jureeporn Jantarapakde, Deondara Trachunthong, Steve Mills, Ravipa Vannakit, Praphan Phanuphak, and Nittaya Phanuphak. "High burden of chlamydia and gonorrhoea in pharyngeal, rectal and urethral sites among Thai transgender women: implications for anatomical site selection for the screening of STI." Sexually Transmitted Infections 95, no. 7 (April 13, 2019): 534–39. http://dx.doi.org/10.1136/sextrans-2018-053835.

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ObjectiveComprehensive data on Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) infections to guide screening services among transgender women (TGW) are limited. We studied the burden of CT/NG infections in pharyngeal, rectal and urethral sites of Thai TGW and determined missed CT/NG diagnoses if selected site screening was performed.MethodsThai TGW were enrolled to the community-led test and treat cohort. CT/NG screening was performed from pharyngeal swab, rectal swab and urine using nucleic acid amplification test. CT/NG prevalence in each anatomical site was analysed, along with the relationships of CT/NG among the three anatomical sites.ResultsOf 764 TGW included in the analysis, 232 (30.4%) had CT/NG infections at any anatomical site, with an overall incidence of 23.7 per 100 person-years. The most common CT/NG infections by anatomical site were rectal CT (19.5%), rectal NG (9.6%) and pharyngeal NG (8.1%). Among 232 TGW with CT/NG infections at any anatomical site, 22%–94.4% of infections would have been missed if single anatomical site testing was conducted, depending on the selected site. Among 668 TGW who tested negative at pharyngeal site, 20.4% had either rectal or urethral infections. Among 583 TGW who tested negative at the rectal site, 8.7% had either pharyngeal or urethral infections. Among 751 TGW who tested negative at the urethral site, 19.2% had either pharyngeal or rectal infections.ConclusionAlmost one-third of Thai TGW had CT/NG infections. All-site screening is highly recommended to identify these infections, but if not feasible rectal screening provides the highest yield of CT/NG diagnoses. Affordable molecular technologies and/or CT/NG screening in pooled samples from different anatomical sites are urgently needed.Trial registration numberNCT03580512.

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Walker, sandra, Clare Bellhouse, Jade Bilardi, Christopher Fairley, and Eric Chow. "P145 Australian MSM’s views and knowledge of pharyngeal gonorrhoea, willingness to change current sexual practices and the acceptability of using mouthwash to reduce the risk of pharyngeal gonorrhoea: A qualitative study." Sexually Transmitted Infections 92, Suppl 1 (June 2016): A70.1—A70. http://dx.doi.org/10.1136/sextrans-2016-052718.199.

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Chow, Eric P. F., Sandra Walker, Tim R. H. Read, Marcus Y. Chen, Catriona S. Bradshaw, and Christopher K. Fairley. "Self-Reported Use of Mouthwash and Pharyngeal Gonorrhoea Detection by Nucleic Acid Amplification Test." Sexually Transmitted Diseases 44, no. 10 (October 2017): 593–95. http://dx.doi.org/10.1097/olq.0000000000000654.

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Beymer, Matthew R., Michelle A. DeVost, Robert E. Weiss, Rhodri Dierst-Davies, Chelsea L. Shover, Raphael J. Landovitz, Corinne Beniasians, et al. "Does HIV pre-exposure prophylaxis use lead to a higher incidence of sexually transmitted infections? A case-crossover study of men who have sex with men in Los Angeles, California." Sexually Transmitted Infections 94, no. 6 (February 27, 2018): 457–62. http://dx.doi.org/10.1136/sextrans-2017-053377.

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BackgroundPre-exposure prophylaxis (PrEP) is an effective method for reducing HIV incidence among at-risk populations. However, concerns exist over the potential for an increase in STIs following PrEP initiation. The objective of this study is to compare the STI incidence before and after PrEP initiation within subjects among a cohort of men who have sex with men in Los Angeles, California.MethodsThe present study used data from patients who initiated PrEP services at the Los Angeles LGBT Center between October 2015 and October 2016 (n=275). A generalised linear mixed model was used with a case-crossover design to determine if there was a significant difference in STIs within subjects 365 days before (before-PrEP period) and 365 days after PrEP initiation (after-PrEP period).ResultsIn a generalised linear mixed model, there were no significant differences in urethral gonorrhoea (P=0.95), rectal gonorrhoea (P=0.33), pharyngeal gonorrhoea (P=0.65) or urethral chlamydia (P=0.71) between periods. There were modest increases in rectal chlamydia (rate ratio (RR) 1.83; 95% CI 1.13 to 2.98; P=0.01) and syphilis diagnoses (RR 2.97; 95% CI 1.23 to 7.18; P=0.02).ConclusionsThere were significant increases in rectal chlamydia and syphilis diagnoses when comparing the periods directly before and after PrEP initiation. However, only 28% of individuals had an increase in STIs between periods. Although risk compensation appears to be present for a segment of PrEP users, the majority of individuals either maintain or decrease their sexual risk following PrEP initiation.

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Artykov, R., R. K. Rabiu, and J. A. White. "O4 Pharyngeal gonorrhoea: assessing treatment responses in an era of uncertainty: Abstract O4 Table 1." Sexually Transmitted Infections 88, Suppl 1 (May 23, 2012): A2.1—A2. http://dx.doi.org/10.1136/sextrans-2012-050601a.4.

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Journal articles on the topic 'Pharyngeal gonorrhoea'

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