Prevalence, incidence and risk factors for pharyngeal gonorrhoea in a community-based HIV-negative cohort of homosexual men in Sydney, Australia

Templeton, David J; Jin, Fengyi; McNally, Leon; Imrie, John; Prestage, Garrett; Donovan, Basil; Cunningham, Philip; Kaldor, John; Kippax, Susan; Grulich, Andrew E.

doi:10.1136/sti.2009.036814

Cited by 67 publications

(64 citation statements)

References 27 publications

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“…Other studies report proportions of symptomatic rectal infections twice as high and symptomatic pharyngeal infections three to five times higher compared to our study 3 5 22 23. These differences can be explained by the differences in data collection.…”

Section: Discussioncontrasting

confidence: 89%

“…Similarly to other studies we observed that rectal symptoms were reported more frequently by those with rectal infection than by those without, while the presence of symptoms did not differ between those with or without pharyngeal infection 3 5 22 23. In our setting a large proportion of infections would remain undetected if only those reporting any symptoms would be tested.…”

Section: Discussionsupporting

confidence: 86%

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Prevalence of pharyngeal and rectalChlamydia trachomatisandNeisseria gonorrhoeaeinfections among men who have sex with men in Germany

et al. 2013

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Section: Discussioncontrasting

confidence: 89%

Section: Discussionsupporting

confidence: 86%

Prevalence of pharyngeal and rectalChlamydia trachomatisandNeisseria gonorrhoeaeinfections among men who have sex with men in Germany

et al. 2013

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“…There have been no reports of studies that have quantified the risk of transmission of gonorrhea from the pharynx or rectum to the male urethra per sexual exposure (8). If the load of N. gonorrhoeae is important in transmission, then these results suggest that transmission may be more likely per sexual exposure from the rectum to the urethra than from the pharynx, particularly for symptomatic rectal infections.…”

mentioning

confidence: 55%

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

et al. 2011

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The bacterial loads for gonococcal infections of the pharynx and rectum were determined among men with male sexual partners. The median bacterial load for rectal infections (18,960 copies/swab) was significantly higher than the load for pharyngeal infections (2,100 copies/swab; P ‫؍‬ 0.001). Bacterial loads among men with symptomatic proctitis were strikingly high (median, 278,000 copies/swab).Gonorrhea is one of the most common sexually transmitted diseases, and study results suggest that rectal gonorrhea enhances HIV transmission (1-3).There are limited data on the transmissibility of gonorrhea, particularly from the pharynx and rectum. To examine potential transmissibility from these sites, we measured gonococcal bacterial loads and examined associated clinical and laboratory factors.All men who have sex with men (MSM) attending the Melbourne Sexual Health Centre between January 2010 and April 2010 who underwent testing for sexually transmitted infections were included. Pharyngeal and rectal specimens were obtained using cotton-tipped swabs. Rectal specimens were obtained either by blind anal swabbing or, in men with symptomatic proctitis, via anoscopy. Swabs were plated onto modified Thayer-Martin medium, placed into phosphate-buffered saline, and then analyzed using real-time quantitative PCR (qPCR) targeting the opa gene of Neisseria gonorrhoeae (4). Positive PCR tests were confirmed using real-time PCR targeting the gonococcal porA pseudogene (7). Gonococcal loads were quantified by comparing the crossing threshold for each sample to the crossing threshold of a standard curve constructed by amplifying different, known copy numbers of N. gonorrhoeae in an opa assay. To determine the adequacy of sample collection, a qPCR targeting the 260-bp region of ␤-globin was performed.Inoculated culture plates were incubated at 36°C in 5% CO 2 for 48 h. Presumptive N. gonorrhoeae colonies were oxidase tested, and identification of specimens to the species level was confirmed by carbohydrate reaction tests. Specimens that were culture positive and/or PCR positive were regarded as representing true infections. The McNemar test was used to compare detection of gonorrhea by culture versus PCR. The Mann-Whitney test was used to compare bacterial loads. The Human Research Ethics Committee of the Alfred Hospital approved the study.Specimens were obtained from 1,076 MSM. The median age of the subjects was 32 (range, 18 to 69). For testing using both culture and PCR, 1,011 rectal and 1,076 pharyngeal specimens were obtained. There were 43 (3.9%) confirmed PCR-positive pharyngeal specimens, of which 17 were also culture positive (sensitivity, 39%). There were 47 (4.6%) confirmed PCR-positive rectal specimens, of which 25 were also culture positive (sensitivity, 53%).Twelve men had concurrent gonorrheal infections of the pharynx and rectum. A further 10 were concurrently infected at the urethra and rectum, while 2 were concurrently infected at the urethra, pharynx, and rectum. Five men were coinfected with rectal chlamydia and g...

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“…A substantial proportion of extra-genital infections (70-90% of rectal and 95-100% of pharyngeal) are asymptomatic (46,82,83). Many pharyngeal infections are restricted to the pharynx (46,84,85). Pharyngeal gonorrhoea has a high incidence: prevalence ratio, suggesting spontaneous resolution (86,87), in contrast to pharyngeal chlamydia, where a high prevalence: incidence ratio supports longer lived infection.…”

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

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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.

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Prevalence, incidence and risk factors for pharyngeal gonorrhoea in a community-based HIV-negative cohort of homosexual men in Sydney, Australia

Cited by 67 publications

References 27 publications

Prevalence of pharyngeal and rectalChlamydia trachomatisandNeisseria gonorrhoeaeinfections among men who have sex with men in Germany

Prevalence of pharyngeal and rectalChlamydia trachomatisandNeisseria gonorrhoeaeinfections among men who have sex with men in Germany

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

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

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