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Clin Infect Dis. 2015 Feb 15;60(4):557-63. doi: 10.1093/cid/ciu873. Epub 2014 Nov 3.

Persistence of Neisseria gonorrhoeae DNA following treatment for pharyngeal and rectal gonorrhea is influenced by antibiotic susceptibility and reinfection.

Author information

1
Melbourne Sexual Health Centre Melbourne School of Population and Global Health, University of Melbourne, Victoria.
2
The University of Queensland, St Lucia Queensland Paediatric Infectious Diseases Laboratory, Royal Children's Hospital, Herston.
3
Melbourne Sexual Health Centre Central Clinical School, Monash University, Melbourne, Victoria.
4
Melbourne Sexual Health Centre.
5
World Health Organization Collaborating Centre for Sexually Transmitted Diseases, SEALS Microbiology, The Prince of Wales Hospital, Randwick University of New South Wales, Kensington, Australia.
6
Melbourne School of Population and Global Health, University of Melbourne, Victoria.

Abstract

BACKGROUND:

To guide interpretation of gonorrhea tests of cure using nucleic acid amplification testing, this study examined the persistence of Neisseria gonorrhoeae DNA following treatment for pharyngeal and rectal gonorrhea.

METHODS:

Men who had sex with men diagnosed with pharyngeal or rectal gonorrhea underwent swabbing from the pharynx or rectum 7 and 14 days following treatment. Repeat testing for N. gonorrhoeae was undertaken using real-time polymerase chain reaction (PCR) assays targeting the opa gene and porA pseudogene.

RESULTS:

One hundred pharyngeal and 100 rectal gonorrhea infections in 190 men were included. For pharyngeal gonorrhea, positivity of N. gonorrhoeae DNA on both PCR assays was present at days 7 or 14 in 13% (95% confidence interval [CI], 6.4%-19.6%) and 8% (95% CI, 2.7%-13.3%), respectively. For rectal gonorrhea, DNA positivity was present in 6% (95% CI, 1.4%-10.7%) and 8% (95% CI, 2.7%-13.3%), respectively. Among 200 baseline pharyngeal and rectal isolates, there were 10 with ceftriaxone minimum inhibitory concentration (MIC) ≥0.06 mg/L and azithromycin MIC ≥0.5 mg/L, of which 3 (30%) had DNA detected at day 14; among the 190 isolates with lower ceftriaxone and azithromycin MICs, only 13 (7%) had persistent DNA (odds ratio, 5.8 [95% CI, 1.3-25.4]; P = .019). One man initially infected with N. gonorrhoeae multiantigen sequence type 2400 had type 4244 infection at day 14, indicating reinfection.

CONCLUSIONS:

Pharyngeal and rectal gonorrhea DNA persisted in 8% of men 14 days after treatment. Persistence was associated with elevated ceftriaxone and azithromycin MICs. Persistence can also reflect reinfection.

KEYWORDS:

gonorrhea; minimum inhibitory concentration of antibiotics; persistent DNA on NAAT testing; reinfection; test of cure

PMID:
25371490
DOI:
10.1093/cid/ciu873
[Indexed for MEDLINE]

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