Comparison of patients diagnosed with gonorrhoea through community screening with those self-presenting to the genitourinary medicine clinic

Abstract

ObjectivesTo compare the clinical, socioeconomic and demographic characteristics of individuals diagnosed with Neisseria gonorrhoeae (NG) in the community using a concomitant nucleic acid amplification test (NAAT, AptimaCombo2) as part of the (community-based) UK Chlamydia Screening Programme (CSP), with those diagnosed in hospital-based genitourinary medicine (GUM) services.DesignA retrospective case note review of all 643 patients treated for NG at a GUM in north west England (January 2007–April 2009).ParticipantsAll 643 treated for NG (including CSP cases, since all cases were referred to GUM for treatment). Limited data were available for 13 CSP cases who failed to attend GUM.Primary outcome measureWhether the case was detected in the community or GUM services. Predictors were demographics (age, gender, postcode for deprivation analysis), sexual history (eg, number of partners) and clinical factors (eg, culture positivity).Results131 cases were diagnosed by CSP (13 of whom did not attend GUM). A further four cases were contacts of these. The GUM caseload was thus inflated by 23% (from 521 to 643). Community cases were overwhelmingly female (85% vs 27% in GUM, p<0.001) and younger (87% females were <25 years vs 70% GUM females, p=0.001). Logistic regression analysis restricted to the target age of the CSP (<25 years) revealed that CSP cases, compared with GUM cases, were more likely to reside in deprived areas (adjusted OR=5.6, 95% CI 1.4 to 21.8 and 5.3, CI 1.7 to 16.6 for the most and second most deprived group respectively, compared with the averagely deprived group, p=0.037) and be asymptomatic (adjusted OR=1.9, CI 1.1 to 3.4, p=0.02).ConclusionsCommunity screening for NG led to a 79% increase in the number of infections detected in women aged <25 years. Screening is targeted at young people, and tends to disproportionately attract young women, a group under-represented at GUM. Screening also contributed further to case detection in deprived areas.

Estimating gonorrhoea prevalence in young heterosexual men and women attending community-based sexual health services to inform decisions on gonorrhoea testing

“…In all community and almost all specialist SHSs, the PPV of reactive gonorrhoea test results would be below the recommended 90% threshold outlined in the UK gonorrhoea testing guidance [6]. Introducing gonorrhoea testing in community SHSs, including existing chlamydia screening programmes, may improve service provision and gonorrhoea detection in populations that do not attend specialist SHSs [10]. However, our analyses suggest that in most community services, the majority of reactive test results would be false positives.…”

A Rare Case of Disseminated Pyogenic Gonococcal Infection in an Immunocompetent Woman

“…Gonococcal disease is generally asymptomatic or mildly symptomatic [1]. Disseminated disease and distal septic complications such as spinal abscesses and pyomyositis have been very rarely reported [2].…”