Data support universal testing for oropharyngeal gonorrhea in MSM

  • van Liere GAFS & al.
  • Clin Infect Dis
  • 26 Sep 2019

  • International Clinical Digest
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Takeaway

  • Routine, universal testing for oropharyngeal Neisseria gonorrhoeae appears to increase detection vs selective testing among men who have sex with men (MSM).
  • >50% of missed infections using selective testing would be oropharyngeal-only and not coincidentally treated with concurrent urogenital or anorectal N gonorrhoeae infections.

Why this matters

  • Consider routine, universal testing vs selective testing to optimize identification/timely treatment of oropharyngeal N gonorrhoeae infections.
  • A large percentage of oropharyngeal N gonorrhoeae infections remain positive between testing and treatment, highlighting risk for transmission between sex partners.

Key results

  • 26,508 selectively tested and 238,619 universally tested MSM (median age, 36 years; interquartile range, 27-47 years).
  • Routine universal oropharyngeal testing was conducted in 90% of consultations.
  • Oropharyngeal N gonorrhoeae prevalence was higher with universal routine vs selective testing (5.5% vs 4.7%, respectively; P<.001>
  • 54.8% (7436/13,568) oropharyngeal infections occurred without concurrent urogenital or anorectal N gonorrhoeae.

Study design

  • Retrospective surveillance data analysis comparing selective oropharyngeal N gonorrhoeae testing vs routine universal testing among Dutch MSM 2008-2017.
  • Funding: Public Health Service South Limburg, the Netherlands.

Limitations

  • Retrospective.
  • False positives.
  • Missed risk factors.
  • No standardised universal testing cutoff.
  • Calendar years, not months defined testing policy.