Abstract
Gonorrhoea incidence has increased substantially in Stockholm during the past years. These increases have coincided with changes in testing practice from solely culture-based to nucleic acid amplification tests (NAAT). Gonorrhoea NAAT is integrated with Chlamydia trachomatis testing and due to opportunistic screening for chlamydia, testing prevalence for gonorrhoea has increased substantially in the Stockholm population. The aim of this study was to examine epidemiological risk-factors for discordant case which are NAAT positive but culture negative. These discordant cases are especially problematic as they give rise to diagnostic and treatment uncertainties with risk for subsequent sequelae. All gonorrhoea cases from Stockholm county during 2011–2012 with at least one positive N. gonorrhoea NAAT test and follow-up cultures were included (N = 874). Data were analysed using multivariate and stratified logistic regression models. Results showed that women were 4-times more likely (OR 4.9; 95% CI 2.4–6.7) than men to have discordant cultures. Individuals tested for gonorrhoea without symptoms were 2.3 times more likely (95% CI 1.5–3.5) than those with symptoms to be discordant. NAAT method and having one week or more between NAAT and culture testing were also indicative of an increased likelihood for discordance. Using NAAT should be based on proper clinical or epidemiological indications and, when positive, followed-up with a culture-based test within one week if possible. Routine gonorrhoea testing is not recommended in low prevalence populations.
Highlights
Gonorrhoea incidence has increased substantially in Stockholm during the past years [1] “Fig 1”
Thirty-three percent of Nucleic Acid Amplification Tests (NAAT) positive cases tested negative in the culture based method (n = 289) (Table 1)
Individuals in the oldest age group had a lower proportion of discordant cases compared to the other age groups
Summary
Gonorrhoea incidence has increased substantially in Stockholm during the past years [1] “Fig 1”. A substantial portion of cases positive with NAAT cannot be verified by culture and it is not possible to determine resistance patterns If these cases are treated, they often receive a standard treatment that may not be effective and potentially lead to an increase in antibiotic resistance [4]. Uncertainty in diagnostics and treatment of NAAT positive, culture negative gonorrhoea can lead to physical complications and to psycho-social complications and distress for those diagnosed. In this emerging field of NAAT-based testing for gonorrhoea, more knowledge is needed on epidemiological risk factors for testing result discordance so as to best inform public health practices optimal for individual infection care. The objective of this study is to examine various epidemiological risk factors for NAAT positive but culture negative gonorrhoea cases to better understand these increasing incidence rate trends and result discordance
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