Culture obtained from urethral swab of asymptomatic men who screen positive for Neisseria gonorrhoeae by urine nucleic acid amplification testing

Ayoma Ratnappuli; Melanie Bissessor; Shehara Arumugam; Deborah A. Williamson; Eric P.F. Chow; Christopher K. Fairley; Jason J. Ong; Vesna De Petra; Marcus Y. Chen

doi:10.1136/sextrans-2020-054690

Culture obtained from urethral swab of asymptomatic men who screen positive for Neisseria gonorrhoeae by urine nucleic acid amplification testing

Ayoma Ratnappuli, Melanie Bissessor^*, Shehara Arumugam, Deborah A. Williamson, Eric P.F. Chow, Christopher K. Fairley, Jason J. Ong, Vesna De Petra, Marcus Y. Chen

^*Corresponding author for this work

School of Medicine

Research output: Contribution to journal › Article › peer-review

Abstract

Background In a previous study of men attending Melbourne Sexual Health Centre who had Neisseria gonorrhoeae detected by urine Aptima Combo 2 (AC2) testing, 11% were asympstomatic. This study aimed to determine whether N. gonorrhoeae can be cultured from asymptomatic men screening positive for N. gonorrhoeae by nucleic acid amplification testing (NAAT) of urine.

Methods Between 1 July 2017 and 31 March 2019, all men attending Melbourne Sexual Health Centre were tested for N. gonorrhoeae by AC2 testing of urine whether urethral symptoms were reported or not. NAAT-positive men were recalled and a urethral swab performed for gonococcal culture using modified Thayer-Martin media with determination of minimum inhibitory concentrations (MICs) by agar dilution.

Results There were 1001 cases (860 individuals) positive for N. gonorrhoeae by urine AC2: 892 (89%) reported urethral symptoms; 109 (11%) did not. Twenty-five asymptomatic cases were excluded because of antibiotic use at or following screening. Of the remaining 84 asymptomatic men, 41 (49%) had a urethral swab performed a median of 5 days after screening. Twenty-one men had urethral discharge at the return visit, 11 of whom reported the discharge at the return visit. Of the 41 men who were swabbed, 31 (76%; 95% CI 60% to 88%) were culture positive for N. gonorrhoeae. Among the 21 men who subsequently developed discharge, 19 (90%; 95% CI 70% to 99%) were culture positive. Among the 20 men who remained asymptomatic, 12 (60%; 95% CI 36% to 81%) were culture positive. MIC profiles were obtained from all isolates.

Conclusions Gonorrhoea was isolated in most but not all asymptomatic men screening positive for N. gonorrhoeae by urine NAAT. Clinicians should consider performing urethral culture in such men to ensure optimal surveillance for antimicrobial resistance. Isolation of N. gonorrhoeae by culture in men without discharge indicates these are true infections with viable organisms.

Original language	English
Pages (from-to)	139-141
Number of pages	3
Journal	Sexually Transmitted Infections
Volume	98
Issue number	2
Early online date	1 Feb 2021
DOIs	https://doi.org/10.1136/sextrans-2020-054690
Publication status	Published - 17 Feb 2022

Keywords

Neisseria gonorrhoeae
Testing
Urethritis

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1136/sextrans-2020-054690

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Ratnappuli, A., Bissessor, M., Arumugam, S., Williamson, D. A., Chow, E. P. F., Fairley, C. K., Ong, J. J., De Petra, V., & Chen, M. Y. (2022). Culture obtained from urethral swab of asymptomatic men who screen positive for Neisseria gonorrhoeae by urine nucleic acid amplification testing. Sexually Transmitted Infections, 98(2), 139-141. https://doi.org/10.1136/sextrans-2020-054690

@article{5bd8d7ed5d0844378295abe1d1b69a50,

title = "Culture obtained from urethral swab of asymptomatic men who screen positive for Neisseria gonorrhoeae by urine nucleic acid amplification testing",

abstract = "Background In a previous study of men attending Melbourne Sexual Health Centre who had Neisseria gonorrhoeae detected by urine Aptima Combo 2 (AC2) testing, 11% were asympstomatic. This study aimed to determine whether N. gonorrhoeae can be cultured from asymptomatic men screening positive for N. gonorrhoeae by nucleic acid amplification testing (NAAT) of urine. Methods Between 1 July 2017 and 31 March 2019, all men attending Melbourne Sexual Health Centre were tested for N. gonorrhoeae by AC2 testing of urine whether urethral symptoms were reported or not. NAAT-positive men were recalled and a urethral swab performed for gonococcal culture using modified Thayer-Martin media with determination of minimum inhibitory concentrations (MICs) by agar dilution. Results There were 1001 cases (860 individuals) positive for N. gonorrhoeae by urine AC2: 892 (89%) reported urethral symptoms; 109 (11%) did not. Twenty-five asymptomatic cases were excluded because of antibiotic use at or following screening. Of the remaining 84 asymptomatic men, 41 (49%) had a urethral swab performed a median of 5 days after screening. Twenty-one men had urethral discharge at the return visit, 11 of whom reported the discharge at the return visit. Of the 41 men who were swabbed, 31 (76%; 95% CI 60% to 88%) were culture positive for N. gonorrhoeae. Among the 21 men who subsequently developed discharge, 19 (90%; 95% CI 70% to 99%) were culture positive. Among the 20 men who remained asymptomatic, 12 (60%; 95% CI 36% to 81%) were culture positive. MIC profiles were obtained from all isolates. Conclusions Gonorrhoea was isolated in most but not all asymptomatic men screening positive for N. gonorrhoeae by urine NAAT. Clinicians should consider performing urethral culture in such men to ensure optimal surveillance for antimicrobial resistance. Isolation of N. gonorrhoeae by culture in men without discharge indicates these are true infections with viable organisms.",

keywords = "Neisseria gonorrhoeae, Testing, Urethritis",

author = "Ayoma Ratnappuli and Melanie Bissessor and Shehara Arumugam and Williamson, {Deborah A.} and Chow, {Eric P.F.} and Fairley, {Christopher K.} and Ong, {Jason J.} and {De Petra}, Vesna and Chen, {Marcus Y.}",

note = "PFC and DAW are supported by an Australian National Health and Medical Research Council (NHMRC) Emerging Leadership Investigator Grant (GNT1172873 and GNT1174555, respectively). CKF is supported by Australian NHMRC Leadership Investigator Grants (GNT1172900).",

year = "2022",

month = feb,

day = "17",

doi = "10.1136/sextrans-2020-054690",

language = "English",

volume = "98",

pages = "139--141",

journal = "Sexually Transmitted Infections",

issn = "1368-4973",

publisher = "BMJ Publishing Group",

number = "2",

}

Ratnappuli, A, Bissessor, M, Arumugam, S, Williamson, DA, Chow, EPF, Fairley, CK, Ong, JJ, De Petra, V & Chen, MY 2022, 'Culture obtained from urethral swab of asymptomatic men who screen positive for Neisseria gonorrhoeae by urine nucleic acid amplification testing', Sexually Transmitted Infections, vol. 98, no. 2, pp. 139-141. https://doi.org/10.1136/sextrans-2020-054690

TY - JOUR

T1 - Culture obtained from urethral swab of asymptomatic men who screen positive for Neisseria gonorrhoeae by urine nucleic acid amplification testing

AU - Ratnappuli, Ayoma

AU - Bissessor, Melanie

AU - Arumugam, Shehara

AU - Williamson, Deborah A.

AU - Chow, Eric P.F.

AU - Fairley, Christopher K.

AU - Ong, Jason J.

AU - De Petra, Vesna

AU - Chen, Marcus Y.

N1 - PFC and DAW are supported by an Australian National Health and Medical Research Council (NHMRC) Emerging Leadership Investigator Grant (GNT1172873 and GNT1174555, respectively). CKF is supported by Australian NHMRC Leadership Investigator Grants (GNT1172900).

PY - 2022/2/17

Y1 - 2022/2/17

N2 - Background In a previous study of men attending Melbourne Sexual Health Centre who had Neisseria gonorrhoeae detected by urine Aptima Combo 2 (AC2) testing, 11% were asympstomatic. This study aimed to determine whether N. gonorrhoeae can be cultured from asymptomatic men screening positive for N. gonorrhoeae by nucleic acid amplification testing (NAAT) of urine. Methods Between 1 July 2017 and 31 March 2019, all men attending Melbourne Sexual Health Centre were tested for N. gonorrhoeae by AC2 testing of urine whether urethral symptoms were reported or not. NAAT-positive men were recalled and a urethral swab performed for gonococcal culture using modified Thayer-Martin media with determination of minimum inhibitory concentrations (MICs) by agar dilution. Results There were 1001 cases (860 individuals) positive for N. gonorrhoeae by urine AC2: 892 (89%) reported urethral symptoms; 109 (11%) did not. Twenty-five asymptomatic cases were excluded because of antibiotic use at or following screening. Of the remaining 84 asymptomatic men, 41 (49%) had a urethral swab performed a median of 5 days after screening. Twenty-one men had urethral discharge at the return visit, 11 of whom reported the discharge at the return visit. Of the 41 men who were swabbed, 31 (76%; 95% CI 60% to 88%) were culture positive for N. gonorrhoeae. Among the 21 men who subsequently developed discharge, 19 (90%; 95% CI 70% to 99%) were culture positive. Among the 20 men who remained asymptomatic, 12 (60%; 95% CI 36% to 81%) were culture positive. MIC profiles were obtained from all isolates. Conclusions Gonorrhoea was isolated in most but not all asymptomatic men screening positive for N. gonorrhoeae by urine NAAT. Clinicians should consider performing urethral culture in such men to ensure optimal surveillance for antimicrobial resistance. Isolation of N. gonorrhoeae by culture in men without discharge indicates these are true infections with viable organisms.

AB - Background In a previous study of men attending Melbourne Sexual Health Centre who had Neisseria gonorrhoeae detected by urine Aptima Combo 2 (AC2) testing, 11% were asympstomatic. This study aimed to determine whether N. gonorrhoeae can be cultured from asymptomatic men screening positive for N. gonorrhoeae by nucleic acid amplification testing (NAAT) of urine. Methods Between 1 July 2017 and 31 March 2019, all men attending Melbourne Sexual Health Centre were tested for N. gonorrhoeae by AC2 testing of urine whether urethral symptoms were reported or not. NAAT-positive men were recalled and a urethral swab performed for gonococcal culture using modified Thayer-Martin media with determination of minimum inhibitory concentrations (MICs) by agar dilution. Results There were 1001 cases (860 individuals) positive for N. gonorrhoeae by urine AC2: 892 (89%) reported urethral symptoms; 109 (11%) did not. Twenty-five asymptomatic cases were excluded because of antibiotic use at or following screening. Of the remaining 84 asymptomatic men, 41 (49%) had a urethral swab performed a median of 5 days after screening. Twenty-one men had urethral discharge at the return visit, 11 of whom reported the discharge at the return visit. Of the 41 men who were swabbed, 31 (76%; 95% CI 60% to 88%) were culture positive for N. gonorrhoeae. Among the 21 men who subsequently developed discharge, 19 (90%; 95% CI 70% to 99%) were culture positive. Among the 20 men who remained asymptomatic, 12 (60%; 95% CI 36% to 81%) were culture positive. MIC profiles were obtained from all isolates. Conclusions Gonorrhoea was isolated in most but not all asymptomatic men screening positive for N. gonorrhoeae by urine NAAT. Clinicians should consider performing urethral culture in such men to ensure optimal surveillance for antimicrobial resistance. Isolation of N. gonorrhoeae by culture in men without discharge indicates these are true infections with viable organisms.

KW - Neisseria gonorrhoeae

KW - Testing

KW - Urethritis

U2 - 10.1136/sextrans-2020-054690

DO - 10.1136/sextrans-2020-054690

M3 - Article

C2 - 33526591

AN - SCOPUS:85100537079

SN - 1368-4973

VL - 98

SP - 139

EP - 141

JO - Sexually Transmitted Infections

JF - Sexually Transmitted Infections

IS - 2

ER -

Culture obtained from urethral swab of asymptomatic men who screen positive for Neisseria gonorrhoeae by urine nucleic acid amplification testing

Abstract

Keywords

UN SDGs

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