Asymptomatic and symptomatic urethral gonorrhoea in men who have sex with men attending a sexual health service

Ong, Jason J.; Fethers, Katherine; Howden, Benjamin P; Fairley, Christopher K; Chow, Eric P F; Williamson, Deborah A.; Petalotis, Irene; Aung, Ei T; Kanhutu, Kudzai; Petra, Vesna De; Chen, M.Y.

doi:10.1016/j.cmi.2017.02.020

Cited by 43 publications

(31 citation statements)

References 17 publications

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“…Also, we only tested men for urethral gonorrhoea if they were symptomatic and hence we may have missed asymptomatic urethral infections. However, previous studies have shown that asymptomatic urethral gonorrhoea is rare, [ 23 , 36 ] hence the omission of asymptomatic urethral screening should not have significantly affected our results. Thirdly, we used culture tests rather than NAAT for detection of gonococci.…”

Section: Discussionmentioning

confidence: 75%

Concordance of gonorrhoea of the rectum, pharynx and urethra in same-sex male partnerships attending a sexual health service in Melbourne, Australia

et al. 2018

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BackgroundWe aimed to describe anatomic site-specific concordance of gonococcal infections in partnerships of men who have sex with men (MSM).MethodsWe conducted a cross-sectional analysis of data from MSM partnerships attending Melbourne Sexual Health Centre between March 2011 and February 2015. Logistic regression models (random effect) were used to examine the association between gonococcal infections of the urethra, rectum and pharynx. Gonococci were detected by culture at all anatomic sites.ResultsThe analysis included 495 partnerships. Of the men with urethral gonorrhoea, 33% (95% CI 18–52) had partners with pharyngeal gonorrhoea and 67% (95% CI 48–82) had partners with rectal gonorrhoea. The adjusted odds of having urethral gonorrhoea was 4.6 (95% CI 1.2–17.1) for a man whose partner had pharyngeal gonorrhoea, and 48.1 (95% CI 18.3–126.7) for a man whose partner had rectal gonorrhoea. Of the men with rectal gonorrhoea, 46% (95% CI 31–61) had a partner with urethral gonorrhoea and 23% (95% CI 12–37) had a partner with pharyngeal gonorrhoea. The adjusted odds of having rectal gonorrhoea was 63.9 (95% CI 24.7–165.6) for a man whose partner had urethral gonorrhoea. Of the men with pharyngeal gonorrhoea, 42% (95% CI 23–63) had a partner with rectal gonorrhoea and 23% (95% CI 9–44) had a partner with had a partner with pharyngeal gonorrhoea. The adjusted odds of having pharyngeal gonorrhoea was 8.9 (95% CI 3.2–24.6) for a man whose partner had rectal gonorrhoea. The crude odds of having pharyngeal gonorrhoea was 14.2 (95% CI 5.1–39.0) for a man whose partner had pharyngeal gonorrhoea.ConclusionsThese data provide the first estimates of concordance of anatomic site-specific gonococcal infections in MSM partnerships, and confirm that urethral gonorrhoea is contracted from both rectal and pharyngeal sites, and suggest that gonococci transmit between the rectum and pharynx. However, due to use of culture rather than NAAT, our analysis was not adequately powered to assess pharynx-to-pharynx transmission of gonococci.

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Section: Discussionmentioning

confidence: 75%

Concordance of gonorrhoea of the rectum, pharynx and urethra in same-sex male partnerships attending a sexual health service in Melbourne, Australia

et al. 2018

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“…Fourth, due to the low rates of testing for gonorrhoea in heterosexual males over the study period, we have had to calculate positivity by using the number of men tested for chlamydia. However, because gonorrhoea is almost always symptomatic in men, 22 this should be a reasonably accurate method for calculating positivity because it is unlikely that those not tested for gonorrhoea would be positive, and this method has been previously used in other studies. 3,11 Thus, our findings may also be biased towards symptomatic males because they are more likely to present at the clinic and test positive.…”

Section: Discussionmentioning

confidence: 99%

Risk factors for urethral gonorrhoea infection among heterosexual males in Melbourne, Australia: 2007–17

et al. 2019

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Background Since 2014 there has been an increase in gonorrhoea among heterosexuals in Australia. Sex with a partner from a country with high gonorrhoea prevalence has been identified as a risk factor for gonorrhoea in heterosexual females, but risk factors for heterosexual males remain unclear. This study determined risk factors for gonorrhoea among heterosexual males. Methods: Retrospective analysis was performed among heterosexual males attending Melbourne Sexual Health Centre (MSHC) between 1 January 2007 and 31 December 2017. Countries for overseas sexual partners were stratified as high-prevalence countries (HPC) or low-prevalence countries (LPC) based on the incidence of gonorrhoea. Results: The annual gonorrhoea positivity increased from 0.72% in 2007 to 1.33% in 2017 (Ptrend <0.001). Males attending MSHC as a contact of gonorrhoea had the highest odds of testing positive (adjusted odds ratio (aOR) 7.46; 95% confidence interval (CI) 4.46–12.49), followed by males identifying as Aboriginal and Torres Strait Islander (aOR 2.57; 95% CI 1.30–5.09), males who had injected drugs in the past 12 months (aOR 2.44; 95% CI 1.39–4.30) and males who had sex with a female from an HPC (aOR 2.18; 95% CI 1.77–2.68). Males aged ≥35 were at higher risk than those aged ≤24 years (aOR 1.44; 95% CI 1.14–1.82). Gonorrhoea positivity increased among males who had sex with females from an LPC (from 0.60% to 1.33%; Ptrend = 0.004) but remained the same over time among males who had sex with females from an HPC (2.14%; Ptrend = 0.143). Conclusions: There was an 80% increase in urethral gonorrhoea among heterosexual males between 2007 and 2017. Having sex with a female from an HPC is a significant risk factor for gonorrhoea. Gonorrhoea positivity among men having sex with a female from an HPC did not change over time, suggesting this risk factor has become less important.

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“…The proportion of asymptomatic NG and CT has been widely reported, but results vary widely around the world, ranging from 8% to 87%. [14][15][16][17] The disparities in the proportion of asymptomatic participants with or without STIs may be attributed to the different laboratory methods employed, the distribution of risk factors and the composition of the population studied. Given that one-third of CT infections are asymptomatic, passive screening in Shenzhen (i.e., screening patients for medical treatment) is not enough.…”

Section: Plos Onementioning

confidence: 99%

Cross-sectional study of asymptomatic Neisseria gonorrhoeae and Chlamydia trachomatis infections in sexually transmitted disease related clinics in Shenzhen, China

et al. 2020

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The aims of this study were to investigate the prevalence and proportion of laboratory-confirmed urethral Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) infections that were asymptomatic among individuals presenting to clinics in Shenzhen and the risk factors related to asymptomatic CT infection. In a cross-sectional study, eligible individuals were invited to participate in the questionnaire, and urine specimens were collected to identify CT and NG infections using a nucleic acid amplification test (NAAT). Considering the differences in the presentation of symptoms between men and women, this study was stratified by gender. Corresponding outcomes were analyzed by Chi-square test and multivariate logistic regression. A total of 2,871 participants were asymptomatic and included in our analyses: 1120 (39.0%) men and 1751 (61.0%) women. The prevalence of asymptomatic NG and CT infections was 0.9% and 6.2% in men, and 0.4% and 7.9% in women, respectively. The proportion of asymptomatic urethral CT among men with urethral CT was 28.3%; for women, it was 34.2%. For asymptomatic men with CT, 3 independent risk factors were identified: (1) men under the age of 30 (aOR, 1.83; 95% CI, 1.11-3.03); (2) being employed in the commercial service work (2.82; 1.36-5.84); and (3) being recruited through the urological department (2.12; 1.19-3.79). For asymptomatic women with urethral CT, age less than 30 years was a risk factor. In conclusion, a substantial prevalence of asymptomatic CT infections was found among men and women presenting to clinics in Shenzhen. The significant correlation between asymptomatic CT infection and these risk factors could help identify high-risk populations and guide screening.

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Asymptomatic and symptomatic urethral gonorrhoea in men who have sex with men attending a sexual health service

Abstract: The findings from our study lend support to guidelines that recommend screening asymptomatic MSM for urethral gonorrhoea.

Cited by 43 publications

References 17 publications

Concordance of gonorrhoea of the rectum, pharynx and urethra in same-sex male partnerships attending a sexual health service in Melbourne, Australia

Concordance of gonorrhoea of the rectum, pharynx and urethra in same-sex male partnerships attending a sexual health service in Melbourne, Australia

Risk factors for urethral gonorrhoea infection among heterosexual males in Melbourne, Australia: 2007–17

Cross-sectional study of asymptomatic Neisseria gonorrhoeae and Chlamydia trachomatis infections in sexually transmitted disease related clinics in Shenzhen, China

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