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. 2016 May 6;11(5):e0155017.
doi: 10.1371/journal.pone.0155017. eCollection 2016.

Gonorrhoea Diagnostic and Treatment Uncertainties: Risk Factors for Culture Negative Confirmation after Positive Nucleic Acid Amplification Tests

Rebecka Vyth  1 , Amy Leval  1   2 , Björn Eriksson  1   2 , Eva-Lena Ericson  3 , Lena Marions  4 , Maria-Pia Hergens  1   2
Affiliations

Gonorrhoea Diagnostic and Treatment Uncertainties: Risk Factors for Culture Negative Confirmation after Positive Nucleic Acid Amplification Tests

Rebecka Vyth et al. PLoS One. .

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.

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Conflict of interest statement

Competing Interests: "The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Trends in gonorrhoea, Stockholm region 2000–201.
See this image and copyright information in PMC

References

    1. Stockholm S. Annual Report. In: Department of Communicable Disease Control and Prevention SR, editor. Stockholm: HSF; 2013.
    1. Velicko I, Unemo M. Recent trends in gonorrhoea and syphilis epidemiology in Sweden: 2007 to 2011. Euro Surveill. 2012;17(29). - PubMed
    1. Gonorrhea: information for medical doctors. Swedish Society for Communicable Disease Control and Prevention 2010.
    1. Unemo M, Nicholas RA. Emergence of multidrug-resistant, extensively drug-resistant and untreatable gonorrhea. Future Microbiol. 2012;7(12):1401–22. 10.2217/fmb.12.117 - DOI - PMC - PubMed
    1. Andric B, Drowos J, Trepka MJ, Suciu G, Alonso A, Hennekens CH. High frequencies of negative pretreatment results following presumptive antibiotic treatment for chlamydia and gonorrhea. South Med J. 2013;106(5):321–6. 10.1097/SMJ.0b013e318291b3c2 . - DOI - PubMed