Persistence of Neisseria gonorrhoeae DNA following treatment for pharyngeal and rectal gonorrhea is influenced by antibiotic susceptibility and re-infection.

Published: November 3, 2014

PubMed
Bissessor M, Whiley DM, Fairley CK, Bradshaw CS, Lee DM, Snow AS, Lahra M, Hocking JS, Chen MY
Original Article:  1.usa.gov/10Bk5B5

Abstract

INTRODUCTION:

To guide interpretation of gonorrhea tests of cure using nucleic acid amplification testing (NAAT), this study examined the persistence of N. gonorrhoeae DNA following treatment for pharyngeal and rectal gonorrhea.

METHODS:

Men who had sex with men diagnosed with pharyngeal or rectal gonorrhea underwent swabbing from the pharynx or rectum 7 and 14 days following treatment. Repeat testing for N. gonorrhoeae was undertaken using real-time PCR assays targeting the opa gene and porA pseudogene.

RESULTS:

100 pharyngeal and 100 rectal gonorrhea infections in 190 men were included. For pharyngeal gonorrhea, positivity of N. gonorrhoeae DNA on both PCR assays was present at days 7 or 14 in 13% (95%CI: 6.4%-19.6%)) and 8% (95% CI: 2.7%-13.3%) respectively. For rectal gonorrhea DNA positivity was present in 6% (95%CI: 1.4%-10.7%) and 8% (95% CI: 2.7%-13.3%) respectively. Among 200 baseline pharyngeal and rectal isolates, there were 10 with ceftriaxone MIC ≥0.06 mg/L and azithromycin MIC ≥0.5 mg/L, of which 3 (30%) had DNA detected at day 14: among the 190 isolates with lower ceftriaxone and azithromycin MICs, only 13 (7%) had persistent DNA (OR=5.8, 95%CI: 1.3-25.4; p=0.019). One man initially infected with NG-MAST type 2400 had type 4244 infection at day 14 indicating reinfection.

CONCLUSION:

  Pharyngeal and rectal gonorrhea DNA persisted in 8% of men 14 days after treatment. Persistence was associated with elevated ceftriaxone and azithromycin MICs. Persistence can also reflect reinfection.

Full text of article available at link below:  1.usa.gov/10Bk5B5
 

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