Frequency of Nucleic Acid Amplification Test Positivity Among Men Who Have Sex With Men Returning for a Test-of-Cure Visit 7 to 30 Days After Treatment of Laboratory-Confirmed Neisseria gonorrhoeae Infection at 2 Public Sexual Health Clinics, New York City, 2013 to 2016

Abstract

A small percent of patients were NG NAAT positive at TOC. Compared with anorectal specimens, urethral specimens were more frequently still positive at TOC. A large proportion of MSM will return for a TOC visit as part of standard clinical care.

Test-of-Cure After Treatment of Pharyngeal Gonorrhea in Durham, North Carolina, 2021–2022

“…We found that those who identified as LGBTQ+ were more likely to return for TOC than WSM and MSW, but we did not find any other associations between return for TOC and age, sex, race/ethnicity, HIV status, PrEP status, or symptom status at the time of presentation. This differed from 1 study of MSM in New York City that found a significant association between older than 30 years and persons without HIV infection and a higher rate of return for TOC, and an association between Black/African American race and not returning for TOC 17 . Another study of MSM in Los Angeles, California found a significant association between taking PrEP and lack of symptoms at the time of testing and a higher rate of return for TOC 16 …”

“…Before the release of the revised CDC treatment guidelines recommending TOC after the treatment of pharyngeal GC, studies investigating TOC in mostly MSM populations in large urban areas found rates of return ranging from 8.5% to 44.2%. [16][17][18] Since the CDC issued revised recommendations in December 2020 for routine TOC in all individuals treated for pharyngeal GC, 15 data are lacking on rates of return for the TOC visit, particularly in to April 2022, we found that only 40.6% of individuals returned for the TOC visit, even though over 83% of individuals were either scheduled for TOC, or efforts were made to schedule them. These findings are consistent with findings from studies performed before the release of the revised CDC recommendations.…”

“…This differed from 1 study of MSM in New York City that found a significant association between older than 30 years and persons without HIV infection and a higher rate of return for TOC, and an association between Black/African American race and not returning for TOC. 17 Another study of MSM in Los Angeles, California found a significant association between taking PrEP and lack of symptoms at the time of testing and a higher rate of return for TOC. 16 Of those who returned for a TOC, 2 (4.9%) had an equivocal test and 1 person (2.4%) had a repeat positive test.…”

“…In studies of MSM with urethral and extragenital GC seen at Sexual Health clinics in large urban areas in the United States, rates of return for TOC vary between 26.3% at 7 days and 44.2% between 7 and 30 days, with 5.3% to 10% of pharyngeal specimens collected at these TOC visits positive for N. gonorrhoeae by NAAT. 16,17 In another study of individuals seen at Sexual Health clinics with pharyngeal GC, of which 83.4% were MSM, 6.0% were men who have sex with women (MSW), and 7.3% were women who have sex with men (WSM), the rate of return for TOC was 8.5% within 30 days of treatment, with 4.3% of pharyngeal specimens positive for N. gonorrhoeae by NAAT at these follow-up visits. 18 Since the CDC issued these revised recommendations in December 2020, data are lacking on rates of return for the TOC, particularly in non-MSM populations.…”

Test of Cure Return Rate and Test Positivity, Strengthening the US Response to Resistant Gonorrhea, United States, 2018–2019

“…3 Data on the proportion of patients who return for a recommended TOC (TOC visit return rates) in the United States have been reported between 8.5% and 44.2%, with 3.4% to 4.6% of nucleic acid amplification test (NAAT) specimens collected at TOC visits positive for N. gonorrhoeae. [10][11][12] However, although reexposure is sometimes assessed (10)(11), AST on specimens collected is not often performed, and reasons for TOC NAAT positivity, other than reinfection, are often not investigated. To date, no data have been published on TOC visit return rates among persons with infections with reduced antibiotic susceptibility (RS).…”