Differing Neisseria gonorrhoeae Bacterial Loads in the Pharynx and Rectum in Men Who Have Sex with Men: Implications for Gonococcal Detection, Transmission, and Control

Bissessor, Melanie; Tabrizi, Sepehr N.; Fairley, Christopher K; Danielewski, Jennifer; Whitton, Bradley; Bird, Susan S.; Garland, Suzanne M.; Chen, M. Y.

doi:10.1128/jcm.05341-11

Cited by 94 publications

(89 citation statements)

References 8 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In 2013, Bissessor et al reported that the gonococcal bacterial DNA load in the pharynx is about 2,100 copies/swab (14), which is almost 80-fold lower than the estimate in our study (1.7 ϫ 10 5 copies/swab). It is possible that the sampling technique may explain the lower levels found in the Bissessor study compared to our study.…”

Section: Discussioncontrasting

confidence: 55%

See 1 more Smart Citation

Neisseria gonorrhoeae Bacterial DNA Load in the Pharynges and Saliva of Men Who Have Sex with Men

et al. 2016

View full text Add to dashboard Cite

e Neisseria gonorrhoeae can be cultured in the saliva of individuals with pharyngeal gonorrhea. The aim of this study was to quantify the gonococcal bacterial DNA loads in the pharynges and saliva among men who have sex with men (MSM) with untreated pharyngeal gonorrhea. Untreated MSM who tested positive for pharyngeal gonorrhea by culture and returned for antibiotic treatment within 14 days at the Melbourne Sexual Health Centre between October 2014 and March 2015 were eligible for this study. The gonococcal bacterial DNA load was measured using real-time quantitative PCR. The median gonococcal bacterial DNA loads in the pharynges and saliva were calculated and compared to culture positivity using the Mann-Whitney U test. A total of 33 men were included in this study. The median gonococcal bacterial DNA load did not differ between the pharynges in men who were culture positive (2.5 ؋ 10 5 copies/swab) and culture negative (2.9 ؋ 10 4 copies/swab) (P ‫؍‬ 0.166) and the saliva (culture positive, 2.2 ؋ 10 5 copies/ml; culture negative, 2.7 ؋ 10 5 copies/ml) (P ‫؍‬ 0.499). The bacterial DNA load in the pharynges (P ‫؍‬ 0.695) and saliva (P ‫؍‬ 0.969) did not differ between who men returned for treatment within 7 days and those who returned 8 to 14 days later. Substantial gonococcal bacterial DNA loads were detected in both saliva and pharynges among MSM with pharyngeal gonorrhea. These findings suggest that gonorrhea can be transmitted via sexual practices involving exposure to saliva, such as oroanal practices (rimming) and saliva use as a lubricant for anal sex.T he high prevalence of gonococcal infection among men who have sex with men (MSM) is a public health issue in many developed countries (1-4). It is important to understand how gonorrhea is transmitted in order to effectively reduce the burden of this epidemic. An Australian-based mathematical model conducted by Hui et al. has shown that gonorrhea cannot be eliminated even if 100% condom use is practiced for anal sex among MSM (5), suggesting that gonorrhea has other routes of transmission other than penile-anal sex. Several observational studies have shown that kissing, oroanal (rimming) practices, oral-penile sex, and saliva use as a lubricant for anal sex are all associated with the detection of gonorrhea (6, 7). All of these sexual activities involve the use and transfer of saliva, indicating that saliva could potentially act as a vehicle for the transmission of gonorrhea during sex. There have been three published studies showing that gonorrhea can be cultured from saliva samples (8-10); however, none of these studies examined the gonococcal bacterial DNA load in saliva. If saliva can act as a medium for gonorrhea transmission, it is important to understand the relative concentrations of bacteria at different anatomical sites to provide further understanding on gonorrhea transmission. The aim of this study was to quantify the gonococcal bacterial DNA loads in saliva and the pharynx. MATERIALS AND METHODSThis cross-sectional study was conducted at the M...

show abstract

Section: Discussioncontrasting

confidence: 55%

“…N. gonorrhoeae contains 11 copies of opa genes and a single copy of the porA gene. The N. gonorrhoeae load was calculated by comparing quantitative PCR (qPCR) crossing points to the standard curve constructed by the amplification of different copy numbers from an opa assay (14).…”

Section: Methodsmentioning

confidence: 99%

Neisseria gonorrhoeae Bacterial DNA Load in the Pharynges and Saliva of Men Who Have Sex with Men

et al. 2016

View full text Add to dashboard Cite

show abstract

“…The subanalysis of PS testing according to anatomical site of infection showed that PS testing performed less well in detecting pharyngeal C. trachomatis (sensitivity, 69% [95% CI, 39 to 91%]) and N. gonorrhoeae (sensitivity, 89% [95% CI, 83 to 94%]). All of the samples for the PS were self-taken swabs, and this lower performance of PS testing in detecting pharyngeal infec- tions may be due to sampling error or the lower organism loads seen in pharyngeal infections (22). There is evidence that the swabbing technique is important for optimal isolation of pharyngeal gonorrhea (23), and inadequate self-sampling could account for the lower detection rates for PS testing.…”

Section: Discussionmentioning

confidence: 99%

The “3 in 1” Study: Pooling Self-Taken Pharyngeal, Urethral, and Rectal Samples into a Single Sample for Analysis for Detection of Neisseria gonorrhoeae and Chlamydia trachomatis in Men Who Have Sex with Men

et al. 2016

View full text Add to dashboard Cite

c Triple-site testing (using pharyngeal, rectal, and urethral/first-void urine samples) for Neisseria gonorrhoeae and Chlamydia trachomatis using nucleic acid amplification tests detects greater numbers of infections among men who have sex with men (MSM). However, triple-site testing represents a cost pressure for services. MSM over 18 years of age were eligible if they requested testing for sexually transmitted infections (STIs), reported recent sexual contact with either C. trachomatis or N. gonorrhoeae, or had symptoms of an STI. Each patient underwent standard-of-care (SOC) triple-site testing, and swabs were taken to form a pooled sample (PS) (pharyngeal, rectal, and urine specimens). The PS was created using two methods during different periods at one clinic, but we analyzed the data in combination because the sensitivity of the two methods did not differ significantly for C. trachomatis (P ‫؍‬ 0.774) or N. gonorrhoeae (P ‫؍‬ 0.163). The sensitivity of PS testing (92%) was slightly lower than that of SOC testing (96%) for detecting C. trachomatis (P ‫؍‬ 0.167). For N. gonorrhoeae, the sensitivity of PS testing (90%) was significantly lower than that of SOC testing (99%) (P < 0.001). When pharynx-only infections were excluded, the sensitivity of PS testing to detect N. gonorrhoeae infections increased to 94%. Our findings show that pooling of self-taken samples could be an effective and cost-saving method, with high negative predictive values. (Interim results of this study were presented at the BASHH 2013 summer meeting.) I n the United States and Europe, genital Chlamydia trachomatis and Neisseria gonorrhoeae are the most prevalent bacterial sexually transmitted infections (STIs). In the United Kingdom, rates of gonorrhea and chlamydia among men who have sex with men (MSM) continue to rise (1), while studies highlight increases in the numbers of HIV-positive and HIV-negative MSM reporting high-risk sexual behavior since the advent of combination antiretroviral therapy (cART) (2-4).Coinfection with an STI and HIV has been shown to increase HIV transmission in epidemiological studies (5-7). Concomitant genital infections have been shown to increase shedding of HIV in the genital tract, in both vaginal secretions and seminal fluid (8, 9). Rectal C. trachomatis/N. gonorrhoeae infections have been associated with HIV acquisition in MSM (10), and it is plausible that they may also enhance HIV transmission.Nucleic acid amplification tests (NAATs) are being used increasingly to screen MSM for pharyngeal and rectal C. trachomatis/N. gonorrhoeae infections, in addition to the use of urethral or first-void urine (FVU) samples, and the use of NAATs is now recommended in national guidelines (11). While there are no NAATs licensed for use with extragenital specimens, several studies have demonstrated that NAATs perform well for the detection of both pharyngeal and rectal C. trachomatis/N. gonorrhoeae infections in . Studies evaluating the performance of these testing methodologies have demonstrated sensitivities and sp...

show abstract

“…NAATs have been shown to be significantly more sensitive than culture in the detection of chlamydia and gonorrhoea, particularly in extra-genital sites (103)(104)(105)(106)(107)(108). Owing to cross-reactivity with nongonorrhoea Neisseria species, all NAAT tests for gonorrhoea from all sites should be confirmed with supplementary tests to improve specificity (109)(110)(111).…”

Section: Chlamydia and Gonorrhoeamentioning

confidence: 99%

2016 United Kingdom national guideline on the sexual health care of men who have sex with men

et al. 2018

View full text Add to dashboard Cite

This guideline is intended for use in UK Genitourinary medicine clinics and sexual health services but is likely to be of relevance in all sexual health settings, including general practice and Contraception and Sexual Health (CASH) services, where men who have sex with men (MSM) seek sexual health care or where addressing the sexual health needs of MSM may have public health benefits. For the purposes of this document, MSM includes all gay, bisexual and all other males who have sex with other males and both cis and trans men. This document does not provide guidance on the treatment of particular conditions where this is covered in other British Association for Sexual Health and HIV (BASHH) Guidelines but outlines best practice in multiple aspects of the sexual health care of MSM. Where prevention of sexually transmitted infections including HIV can be addressed as an integral part of clinical care, this is consistent with the concept of combination prevention and is included. The document is designed primarily to provide guidance on the direct clinical care of MSM but also makes reference to the design and delivery of services with the aim of supporting clinicians and commissioners in providing effective services. Methodology This document was produced in accordance with the guidance set out in the BASHH CEG’s document ‘Framework for guideline development and assessment’ published in 2010 at http://www.bashh.org/guidelines and with reference to the Agree II instrument. Following the production of the updated framework in April 2015, the GRADE system for assessing evidence was adopted and the draft recommendations were regraded. Search strategy (see also Appendix 1) Ovid Medline 1946 to December 2014, Medline daily update, Embase 1974 to December 2014, Pubmed NeLH Guidelines Database, Cochrane library from 2000 to December 2014. Search language English only. The search for Section 3 was conducted on PubMed to December 2014. Priority was given to peer-reviewed papers published in scientific journals, although for many issues evidence includes conference abstracts listed on the Embase database. In addition, for ‘Identification of problematic recreational drug and alcohol use’ section and ‘Sexual problems and dysfunctions in MSM’ section, searches included PsycINFO. Methods Article titles and abstracts were reviewed and if relevant the full text article was obtained. Priority was given to randomised controlled trial and systematic review evidence, and recommendations made and graded on the basis of best available evidence. Piloting and feedback The first draft of the guideline was circulated to the writing group and to a small group of relevant experts, third sector partners and patient representatives who were invited to comment on the whole document and specifically on particular sections. The revised draft was reviewed by the CEG and then reviewed by the BASHH patient/public panel and posted on the BASHH website for public consultation. The final draft was piloted before publication. Guideline update The guidelines will be reviewed and revised in five years’ time, 2022.

show abstract

Differing Neisseria gonorrhoeae Bacterial Loads in the Pharynx and Rectum in Men Who Have Sex with Men: Implications for Gonococcal Detection, Transmission, and Control

Cited by 94 publications

References 8 publications

Neisseria gonorrhoeae Bacterial DNA Load in the Pharynges and Saliva of Men Who Have Sex with Men

Neisseria gonorrhoeae Bacterial DNA Load in the Pharynges and Saliva of Men Who Have Sex with Men

The “3 in 1” Study: Pooling Self-Taken Pharyngeal, Urethral, and Rectal Samples into a Single Sample for Analysis for Detection of Neisseria gonorrhoeae and Chlamydia trachomatis in Men Who Have Sex with Men

2016 United Kingdom national guideline on the sexual health care of men who have sex with men

Contact Info

Product

Resources

About