P3 An audit of pharyngealneisseria gonorrhoeaetreatment and test of cure practices

Abstract

Background Pharyngeal Neisseria gonorrhoeae infections are usually asymptomatic and often diagnosed using nucleic acid amplification tests (NAATs). This reservoir of bacteria may contribute to antibiotic resistance through recombination with pharyngeal commensal bacteria. Therefore adherence to treatment guidelines is imperative and guidelines recommend a test of cure (TOC) after treatment. Objective To evaluate adherence to local guidelines of treating Neisseria gonorrhoeae pharyngeal infection and TOC results. Methods Retrospective case note review of all male positive pharyngeal GC NAAT tests at a sexual health clinic in 2013. The treatment and TOC details were evaluated. Results Of 133 positive NAATs, 125/133 received treatment at our clinic. 83%(104/125) received first line treatment and 74%(93/125) returned for a TOC. The mean return time for negative TOC tests was 25 ± 9 days. 3 patients remained GC NAAT positive at TOC and 2 indeterminate, at 22 ± 3 days after treatment. 4/5 received first line treatment and 1/5 received second line, due to allergy. Without further treatment, all repeat NAAT tests were negative and all five cultures did not grow Neisseria gonorrhoeae . All 5 were asymptomatic and denied sexual contact between treatment and TOC. None were co-infected with other STI’s. Discussion/conclusion There was a high return rate for TOC and high levels of adherence to the local treatment protocol. Those with positive or indeterminate TOC had no distinguishing features or treatment differences, compared with those who tested negative. The treatment to TOC times for both groups was beyond guideline recommendations. Repeat negative NAAT testing suggests no treatment failure in these cases.