Oropharyngeal and Genital Gonorrhea Infections Among Women and Heterosexual Men Reporting Sexual Contact With Partners With Gonorrhea: Implication for Oropharyngeal Testing of Heterosexual Gonorrhea Contacts.

Abstract

There have been very limited studies of oropharyngeal gonorrhea in heterosexuals. Routine screening of oropharyngeal gonorrhea is not recommended in heterosexual contacts of gonorrhea. This study aimed to examine oropharyngeal gonorrhea positivity among heterosexuals reporting contact with a partner with gonorrhea. At the Melbourne Sexual Health Centre (MSHC), all heterosexual individuals reporting contact with sexual partners with gonorrhea are tested for genital gonorrhea. In May 2017, MSHC also included screening for oropharyngeal gonorrhea in heterosexual contacts of gonorrhea. All contacts of gonorrhea among women and heterosexual men between May 2017 and November 2018 were reviewed. Site-specific gonorrhea positivity was also calculated. One hundred ninety-one gonorrhea contacts (102 heterosexual men and 89 women) were reviewed. The median age was 28 (interquartile range, 24-33) years. The gonorrhea positivity in males was significantly higher at the oropharynx compared with urethra (18%; 95% confidence interval [CI], 11% to 26% vs 2%; 95% CI, 0% to 7%; P < 0.001); and higher at the oropharynx compared with cervicovaginal site in women (46%; 95% CI, 35% to 57% vs 36%; 95% CI, 26% to 47%; P = 0.056). Of the 100 men who did not have genital gonorrhea, 17 (18%; 95% CI, 10% to 26%) tested positive at the oropharynx. Of the 55 women who did not have genital gonorrhea, 21 (24%; 95% CI, 15% to 34%) tested positive at the oropharynx. Infection at both the oropharynx and genital sites was not associated with sex worker status in women. Overall, 89% and 40% of gonorrhea in heterosexual men and women were only in the oropharynx, respectively. Oropharyngeal gonorrhea testing among heterosexual contacts of gonorrhea may be indicated given a substantial proportion of gonorrhea contacts are only infected at this site.