Clinical Spectrum of Pharyngeal Gonococcal Infection

Wiesner, Paul J.; Tronca, Evelyn; Bonin, Paul D.; Pedersen, Alf H. B.; Holmes, King K.

doi:10.1056/nejm197301252880404

Cited by 225 publications

(100 citation statements)

References 22 publications

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“…STI viruses found in the oral cavity include Epstein Barr virus [47], herpes simplex viruses type 1 and type 2 [72], human papilloma virus [33,38,53,58], hepatitis B [8], and cytomegalovirus [36]. Bacterial infections include syphilis [22,23], Donovanosis [25,55], chancroid [30,50] and oropharyngeal gonorrhea [24,70]. Primary lesions of lymphogranuloma venereum caused by C. trachomatis are also found in the oral cavity [3,17].…”

Section: Discussionmentioning

confidence: 99%

Oral Chlamydia trachomatis in patients with established periodontitis

Reed

Lopatin

Foxman

et al. 2000

Clinical Oral Investigations

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Periodontitis is considered a consequence of a pathogenic microbial infection at the periodontal site and host susceptibility factors. Periodontal research supports the association of Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia, and Bacteroides forsythus, and periodontitis; however causality has not been demonstrated. In pursuit of the etiology of periodontitis, we hypothesized that the intracellular bacteria, Chlamydia trachomatis, may play a role. As a first step, a cross-sectional study of dental school clinic patients with established periodontitis were assessed for the presence of C. trachomatis in the oral cavity, and in particular from the lining epithelium of periodontal sites. C. trachomatis was detected using a direct fluorescent monoclonal antibody (DFA) in oral specimens from 7% (6/87) of the patients. Four patients tested positive in specimens from the lining epithelium of diseased periodontal sites, one patient tested positive in healthy periodontal sites, and one patient tested positive in the general mucosal specimen. In conclusion, this study provides preliminary evidence of C. trachomatis in the periodontal sites. Planned studies include the use of a more precise periodontal epithelial cell collection device, the newer nucleic acid amplification techniques to detect C. trachomatis, and additional populations to determine the association of C. trachomatis and periodontitis.

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Section: Discussionmentioning

confidence: 99%

Oral Chlamydia trachomatis in patients with established periodontitis

Reed

Lopatin

Foxman

et al. 2000

Clinical Oral Investigations

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“…Also, it should be noted that debate is ongoing over the clinical significance of pharyngeal gonorrhea, with suggestions that pharyngeal gonorrhea may spontaneously clear or otherwise not make a significant contribution to transmission of disease. [83][84][85][86][87] However, it is also recognized that pharyngeal carriage predisposes to disseminated gonococcal infection. 87 …”

Section: Diagnosis Of Pharyngeal and Rectal Gonorrheamentioning

confidence: 99%

“…[83][84][85][86][87] However, it is also recognized that pharyngeal carriage predisposes to disseminated gonococcal infection. 87 …”

Section: Diagnosis Of Pharyngeal and Rectal Gonorrheamentioning

confidence: 99%

Nucleic Acid Amplification Testing for Neisseria gonorrhoeae

Whiley

Tapsall

Sloots

2006

The Journal of Molecular Diagnostics

178

163

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Nucleic acid amplification tests (NAATs) for the detection of Neisseria gonorrhoeae became available in the early 1990s. Although offering several advantages over traditional detection methods, N. gonorrhoeae NAATs do have some limitations. These include cost, risk of carryover contamination, inhibition, and inability to provide antibiotic resistance data. In addition, there are sequence-related limitations that are unique to N. gonorrhoeae NAATs. In particular, falsepositive results are a major consideration. These primarily stem from the frequent horizontal genetic exchange occurring within the Neisseria genus, leading to commensal Neisseria species acquiring N. gonorrhoeae genes. Furthermore, some N. gonorrhoeae subtypes may lack specific sequences targeted by a particular NAAT. Therefore, NAAT false-negative results because of sequence variation may occur in some gonococcal populations. Overall, the N. gonorrhoeae species continues to present a considerable challenge for molecular diagnostics. The need to evaluate N. gonorrhoeae NAATs before their use in any new patient population and to educate physicians on the limitations of these tests is emphasized in this review.

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“…Among some subgroups, such as men who have sex with men (MSM), oral sex is more common than rectal sex and may represent the only site of sexual exposure (14). Thus, oral sex is not uncommon, both among heterosexuals and among MSM, and oral-genital contact places persons at risk for the acquisition of pharyngeal gonococcal infection, which may be transmitted to others (11), and for complications, including disseminated gonococcal infection (1,3,22,24).The majority of pharyngeal gonococcal infections are asymptomatic, and, thus, without accurate risk assessment and sensitive diagnostic methods, many of these infections are not diagnosed or effectively treated, providing a reservoir of disease in the community (13,16). Estimates of the prevalence of gonococcal pharyngeal infection vary substantially according to the population studied.…”

mentioning

confidence: 99%

Nucleic Acid Amplification Tests for Diagnosis of Neisseria gonorrhoeae Oropharyngeal Infections

et al. 2009

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The optimal methods for the diagnosis of pharyngeal Neisseria gonorrhoeae infection are uncertain. The objective of this study was to define the performance of culture and nucleic acid amplification tests (NAATs) for the diagnosis of pharyngeal N. gonorrhoeae. In this cross-sectional study, males and females >15 years old who acknowledged performing fellatio or cunnilingus (in the previous 2 months) were recruited from three clinics (two human immunodeficiency virus clinics and one sexually transmitted diseases clinic) located in Birmingham, AL. The test performance of culture for N. gonorrhoeae, the Gen-Probe Aptima Combo 2 transcription-mediated amplification assay (TMA), the BD ProbeTec ET amplified DNA strand displacement assay (SDA), and the Roche Cobas Amplicor PCR was defined by using a rotating "gold standard" of any positive results by two or three of the three tests that excluded the test being evaluated. A total of 961 evaluable test sets were collected. On the basis of a rotating gold standard of positive results by two of three comparator tests, the sensitivity and the specificity were as follows: culture for N. gonorrhoeae, 50.0% and 99.4%, respectively; PCR, 80.3% and 73.0%, respectively; TMA, 83.6% and 98.6%, respectively; and SDA, 93.2% and 96.3%, respectively. On the basis of a rotating gold standard of positive results by three of three comparator tests, the sensitivity and specificity were as follows: culture for N. gonorrhoeae, 65.4% and 99.0%, respectively; PCR, 91.9% and 71.8%, respectively; TMA, 100% and 96.2%, respectively; and SDA, 97.1% and 94.2%, respectively. In conclusion, currently available NAATs are more sensitive than culture for the detection of pharyngeal gonorrhea in at-risk patients. PCR is substantially less specific than culture, TMA, or SDA and should not be used for the detection of pharyngeal gonorrhea.In the latter part of the 1990s, testing for Neisseria gonorrhoeae genital infections was revolutionized by the introduction of nucleic acid amplification tests (NAATs), which achieve sensitivities greater than those of traditional culture methods and which also allow the use of simplified means of specimen collection. For testing of specimens from genital sites, these tests have been found to be preferred by patients (because specimens can be collected less invasively) and by clinicians (because of the ease of specimen collection and increased sensitivity) and permit expanded screening both in traditional clinical settings and at outreach sites where testing has not typically been performed. At present, however, there are few published data on the performance of NAATs commercially available in the United States for the diagnosis of N. gonorrhoeae infections at nongenital sites of exposure.Recent data suggest that oral-genital sexual contact is relatively common and may be increasing among Americans, particularly adolescents and young adults (7,15,17,18). The importance of the oropharynx as a potential site of infection is further emphasized by a recent population-based s...

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Clinical Spectrum of Pharyngeal Gonococcal Infection

Cited by 225 publications

References 22 publications

Oral Chlamydia trachomatis in patients with established periodontitis

Oral Chlamydia trachomatis in patients with established periodontitis

Nucleic Acid Amplification Testing for Neisseria gonorrhoeae

Nucleic Acid Amplification Tests for Diagnosis of Neisseria gonorrhoeae Oropharyngeal Infections

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