Oropharyngeal gonorrhoea: rate of co-infection with sexually transmitted infection, antibiotic susceptibility and treatment outcome

Abstract

The aim of the present study is to investigate the rate of co-infections with other sexually transmitted infections (STIs), antibiotic susceptibility and management of oropharyngeal gonorrhoea diagnosed in a busy genitourinary medicine clinic. The method involved a retrospective study on consecutive patients diagnosed with oropharyngeal gonorrhoea. A total of 131 patients were diagnosed with oropharyngeal gonorrhoea over the study period. The median age of the infected patients was 28 (interquartile range: 22 to 35) years. Forty-one (31%) of patients were younger than 24 years. High rates of co-infection with urethral gonorrhoea (37%), rectal gonorrhoea (37%) or chlamydial infection (16%) were identified. Thirty patients (23%) had only oropharyngeal infection. Twenty-two (17%) patients' isolates showed resistance to at least one antibiotic. Antibiotic resistance among oropharyngeal gonococcal isolates was above 5% between 2000 and 2009. Test-of-cure (TOC) was carried out for only 63 (48%) of patients; none had positive culture. Among 46 isolates treated with cefixime 400 mg/stat, 27 (59%) had TOC; all were negative. Repeat TOC was not carried out for any of the patients. In conclusion, successful management of oropharyngeal gonorrhoea should comprise of counselling, partner notification and TOC after treatment with appropriate antibiotic regimen.

What is needed to guide testing for anorectal and pharyngeal Chlamydia trachomatis and Neisseria gonorrhoeae in women and men? Evidence and opinion

“…Pharyngeal CT prevalence is low in MSM and in women (see Table 1 ), and in both sexes frequently occurs in the absence of anorectal or genital CT, e.g. of pharyngeal CT 32–44 % was single in women and 53–85 % in MSM [ 18 , 32 , 33 , 43 – 47 ]. Pharyngeal NG prevalence is higher in MSM than in women (see Table 1 ), and also frequently occurs as a single infection in both sexes.…”

“…Unfortunately, the recommendation to restrict testing to certain exposure risks has not been based on evidence. Actual testing results show that extra-genital testing of all people reporting extra-genital exposure would still result in over half of extra-genital infections remaining undetected in both women (see Table 2 ) and in MSM who attend health care for genital testing [ 11 , 18 , 24 , 25 , 32 – 39 , 43 – 47 ]. The prevalence of anorectal CT was consistently similar between women reporting and not reporting (receptive) anal sex, as shown in Table 2 .…”

“…There is little or no evidence that CT strains differ between anatomic sites regarding their genotype or their pathogenic potential. In MSM, some studies demonstrated associations between anorectal NG infections, anorectal NG bacterial load and proctitis [ 35 , 47 , 60 ]. Still, it should be noted that generally anorectal symptoms are rarely reported (<5 %) and that most extra-genital infections are without symptoms.…”

HIV, Rectal Chlamydia, and Rectal Gonorrhea in Men Who Have Sex With Men Attending a Sexually Transmitted Disease Clinic in a Midwestern US City

“…The median prevalence of N. gonorrhoeae (GC) and C. trachomatis (CT) among US MSM attending STD Surveillance Network clinics in 2010 (including rectal, urethral and oropharyngeal infections with these pathogens) was 15.5% and 13.0%, respectively (3). Focusing just on rectal GC and CT, prevalence estimates in MSM as high as 38% for rectal GC (4) and 24% for rectal CT (5) have been documented. By contrast, in nationally-representative National Health and Nutrition Examination Survey data, 14-39 year-old men and women had urethral GC and CT prevalence of 0.24% and 2.2%, respectively (6).…”

Appropriate Time for Test-of-Cure when Diagnosing Gonorrhoea with a Nucleic Acid Amplification Test

“…Indications for TOC are: persistence of symptoms, re-exposure to infection, possible antimicrobial resistance, stipulated by national practice or in case of pharyngeal infections. Manavi et al (19) also recommends TOC for pharyngeal infections because of higher rate of treatment failure. Accordingly, pharyngeal gonococcal infections, in particular, pose an additional problem because these can be difficult to treat (20)(21)(22), and are often asymptomatic, resulting in potential reservoirs for further transmission.…”