Clinical presentation of asymptomatic and symptomatic women who tested positive for genital gonorrhoea at a sexual health service in Melbourne, Australia

Abstract

Gonorrhoea cases in women have been rising in Australia in the 2010s but the cause of the increase is not well understood. This cross-sectional study aimed to describe the characteristics of genital gonorrhoea infection in women attending the Melbourne Sexual Health Centre, Australia. Gonorrhoea cases were diagnosed by nucleic acid amplification test (NAAT) and/or culture. Genitourinary specimens were obtained in 12 869 clinic visits in women aged 16 years or above between August 2017 and August 2018. Genital gonorrhoea was detected in 142 (1.1%) of the visits. Almost half of the cases were asymptomatic, 47.9% [95% confidence interval (CI) 39.8-56.1%]; yellow, green or pus-like vaginal discharge was present in 11.3% (95% CI 7.0-17.6%) and other genital symptoms in 40.8% (95% CI 33.1-49.1%) of the cases. The mean time between last sexual contact and onset of symptoms was 7.3 days and between the onset of symptoms to presentation to the clinic was 12.1 days. Half of the cases of genital gonorrhoea among women are asymptomatic and these cases would have been missed by testing of only symptomatic women. Further epidemiological and behavioural research is required to understand the temporal changes in sexual practices among women in Australia.

Patterns of Sexual Practices, Sexually Transmitted Infections and Other Genital Infections in Women Who Have Sex with Women Only (WSWO), Women Who Have Sex with Men Only (WSMO) and Women Who Have Sex with Men and Women (WSMW): Findings from a Sexual Health Clinic in Melbourne, Australia, 2011–2019

“…However, these data must be interpreted with caution as the number of women who reported intravenous drug use was small in our study (n = 254). Similar patterns can also be observed in studies defining WSW according to sexual orientation (i.e., lesbian, bisexual, or heterosexual); a 2013 Australian populationbased study (Roxburgh et al, 2016) demonstrated more than a fourfold higher odds of intravenous drug use among lesbian and bisexual women in comparison to heterosexual women, and similar patterns can be observed when comparing gay and bisexual men to heterosexual men (Martin-Sanchez et al, 2020a, 2020b, 2020cPhillips et al, 2019). These findings may be due to stigmatization associated with sexual minority status and social norms in the LGBTQIA + community (Corliss et al, 2006).…”

“…Before August 2017, asymptomatic screening for gonorrhea in women (except sex workers) was not recommended as per the Australian STI Management Guidelines (Australasian Sexual Health Alliance, 2019 ) and only women presenting with genital symptoms or who were self-reported contacts of a partner with gonorrhea were tested at MSHC. After August 2017, however, all women attending MSHC were offered screening for gonorrhea, regardless of the presence of symptoms (Martin-Sanchez et al, 2020a , 2020b , 2020c ).…”

“…Prior to this time, only women who were symptomatic or who were contacts of a known gonorrhea case were offered gonorrhea screening at MSHC, meaning that a large number of asymptomatic women may have been missed. This is supported by a 2020 studying highlighting that up to half of cases of gonorrhea in women are asymptomatic (Martin-Sanchez et al, 2020a, 2020b, 2020c. Finally, limitations may have arisen due to the low numbers of WSWO in comparison to WSMO.…”

“…Currently in Australia, there are limited published STI data that examine the subpopulation of women who have sex with women (WSW). In contrast, extensive STI data exist for Australian men who have sex with men (MSM), and numerous epidemiological studies have established that in males, STI risk is higher among MSM compared with men who have sex with women only (Australian Government Department of Health, 2018 ; Chow et al, 2019a , 2019b ; Jasek et al, 2017 ; Martin-Sanchez et al, 2020a , 2020b , 2020c ). Given the lack of corresponding data in women, it is difficult to extrapolate whether similar patterns can be observed in Australian WSW, and if STI patterns or prevalence vary depending on whether women have sex with exclusively men, exclusively women, or both.…”

Oropharyngeal gonorrhoea infections among heterosexual women and heterosexual men with urogenital gonorrhoea attending a sexual health clinic in Melbourne, Australia

“…In May 2017, MSHC introduced oropharyngeal gonorrhoea testing for all women and heterosexual men if they reported sexual contact with partners known to have gonorrhoea [16]. In August 2017, MSHC introduced oropharyngeal gonorrhoea testing for all women and heterosexual men with untreated urogenital gonorrhoea, regardless of the presence of symptoms [17,18]. We defined 'heterosexual' as individuals who did not have sex with a same-sex partner within the previous 12 months, and 'contact of gonorrhoea' as individualsdregardless of the presence of urogenital symptomsdwho self-reported sexual contact with partners known to have gonorrhoea.…”