P2.033 Isolation ofNeisseria Gonorrhoeaefrom the Tonsils and Posterior Oropharynx Using Culture

Abstract

estimated the rate of lost to follow up cases (visitors with a false negative Gram result who did not come back for treatment) in the 2 periods. Results Gram strain microscopy had a high specificity, in both time periods regardless of sex (> = 99.8). Sensitivity decreased overall comparing years before and after 2010, from 87.2 to 84.8. This was mainly due to a sharp reduction of the already low sensitivity in women after 2010 from 32.0 to 23.1. Sensitivity in men remained high at 95.9 before 2010 and 95.4 thereafter. Loss to follow-up was estimated at 4.3% (2/47) before 2010 and 5.9% (8/135) after 2010. Overall, over 99% of all culture positive patients were treated. Discussion The low sensitivity of Gram stain microscopy in females is known, but our results show that sensitivity to diagnose gonorrhoea is even lower when offered solely to symptomatic women. Although it did not have an impact on the number of treated infections, this counter-intuitive result could potentially lead to undertreatment and to be considered syndromic treatment policies. Introduction Commercial biochemical tests are typically used for the identification of N. gonorrhoeae isolates, however certain methods can exhibit specificity problems when testing commensal Neisseria strains. The aim of this study was to assess rates of phenotypic misidentification of N. gonorrhoeae in Australia. Methods A total of 2373 isolates were received from reference laboratories throughout Australia in the first half of 2012, and comprised 98% of all gonococci isolated in Australia during this period. A NAtioNAl QuAlityTo confirm organism identity, all isolates were tested using in-house N. gonorrhoeae real-time PCR assays targeting multicopy opa, porA pseudogene and cppB genes. ResultsThe results showed that 98.5% (2336/2373) of isolates were positive for all three gene targets, 31 positive for two targets (3 porA-negative, 1 opa negative and 27 cppB-negative) and 6 were negative by all 3 PCR targets. Using 16S rDNA sequencing, 4 of the latter 6 isolates were determined to be non-gonococcal species (Moraxella and commensal Neisseria) whereas two isolates could not be identified. (GEN-PROBE). In addition swabs are collected from a limited number of high risk patients for culture and susceptibility testing. The isolates can also be used for molecular characterization of resistance determinants and strain typing. In order to gain a better understanding of the circulating sequence types (STs) and resistance determinants in cases where specimens are not collected for culture, such as community patients, a more practical approach would be to test the original sample submitted for Aptima testing by molecular methods. Methods Sample pairs (specimen submitted for Aptima testing and culture within one day) from 26 patients including 22 males and 4 females ranging in age from 20 to 59 years were extracted using the QIAamp DNA mini kit and compared for direct molecular characterization. Samples were analysed for antimicrobial susceptibility based on mosiac changes tha...

Spontaneous clearance of genital and extragenitalNeisseria gonorrhoeae: data from GToG

“…The frequency of clearance at either extragenital or genital sites, how rapidly it occurs and potential mediating factors, such as previous infection or antibody production, have not been fully explored. 2 The pharynx is the most common site from which spontaneous clearance of NG has previously been reported, [3][4][5][6][7][8] with additional studies referring to 'extra-genital' infection without being more specific. [9][10][11][12] Spontaneous clearance is often reported as a secondary endpoint with limited detail provided.…”