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Persistence of Neisseria gonorrhoeae DNA following treatment for pharyngeal and rectal gonorrhea is influenced by antibiotic susceptibility and reinfection.
Clin Infect Dis. 2015 Feb 15; 60(4):557-63.CI

Abstract

BACKGROUND

To guide interpretation of gonorrhea tests of cure using nucleic acid amplification testing, this study examined the persistence of Neisseria 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 polymerase chain reaction (PCR) assays targeting the opa gene and porA pseudogene.

RESULTS

One hundred 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% confidence interval [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 minimum inhibitory concentration (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 (odds ratio, 5.8 [95% CI, 1.3-25.4]; P = .019). One man initially infected with N. gonorrhoeae multiantigen sequence type 2400 had type 4244 infection at day 14, indicating reinfection.

CONCLUSIONS

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.

Authors+Show Affiliations

Melbourne Sexual Health Centre Melbourne School of Population and Global Health, University of Melbourne, Victoria.The University of Queensland, St Lucia Queensland Paediatric Infectious Diseases Laboratory, Royal Children's Hospital, Herston.Melbourne Sexual Health Centre Central Clinical School, Monash University, Melbourne, Victoria.Melbourne Sexual Health Centre Central Clinical School, Monash University, Melbourne, Victoria.Melbourne Sexual Health Centre.Melbourne Sexual Health Centre.World Health Organization Collaborating Centre for Sexually Transmitted Diseases, SEALS Microbiology, The Prince of Wales Hospital, Randwick University of New South Wales, Kensington, Australia.Melbourne School of Population and Global Health, University of Melbourne, Victoria.Melbourne Sexual Health Centre Central Clinical School, Monash University, Melbourne, Victoria.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

25371490

Citation

Bissessor, Melanie, et al. "Persistence of Neisseria Gonorrhoeae DNA Following Treatment for Pharyngeal and Rectal Gonorrhea Is Influenced By Antibiotic Susceptibility and Reinfection." Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America, vol. 60, no. 4, 2015, pp. 557-63.
Bissessor M, Whiley DM, Fairley CK, et al. Persistence of Neisseria gonorrhoeae DNA following treatment for pharyngeal and rectal gonorrhea is influenced by antibiotic susceptibility and reinfection. Clin Infect Dis. 2015;60(4):557-63.
Bissessor, M., Whiley, D. M., Fairley, C. K., Bradshaw, C. S., Lee, D. M., Snow, A. S., Lahra, M. M., Hocking, J. S., & Chen, M. Y. (2015). Persistence of Neisseria gonorrhoeae DNA following treatment for pharyngeal and rectal gonorrhea is influenced by antibiotic susceptibility and reinfection. Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America, 60(4), 557-63. https://doi.org/10.1093/cid/ciu873
Bissessor M, et al. Persistence of Neisseria Gonorrhoeae DNA Following Treatment for Pharyngeal and Rectal Gonorrhea Is Influenced By Antibiotic Susceptibility and Reinfection. Clin Infect Dis. 2015 Feb 15;60(4):557-63. PubMed PMID: 25371490.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Persistence of Neisseria gonorrhoeae DNA following treatment for pharyngeal and rectal gonorrhea is influenced by antibiotic susceptibility and reinfection. AU - Bissessor,Melanie, AU - Whiley,David M, AU - Fairley,Christopher K, AU - Bradshaw,Catriona S, AU - Lee,David M, AU - Snow,Anthony S, AU - Lahra,Monica M, AU - Hocking,Jane S, AU - Chen,Marcus Y, Y1 - 2014/11/03/ PY - 2014/11/6/entrez PY - 2014/11/6/pubmed PY - 2015/9/4/medline KW - gonorrhea KW - minimum inhibitory concentration of antibiotics KW - persistent DNA on NAAT testing KW - reinfection KW - test of cure SP - 557 EP - 63 JF - Clinical infectious diseases : an official publication of the Infectious Diseases Society of America JO - Clin Infect Dis VL - 60 IS - 4 N2 - BACKGROUND: To guide interpretation of gonorrhea tests of cure using nucleic acid amplification testing, this study examined the persistence of Neisseria 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 polymerase chain reaction (PCR) assays targeting the opa gene and porA pseudogene. RESULTS: One hundred 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% confidence interval [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 minimum inhibitory concentration (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 (odds ratio, 5.8 [95% CI, 1.3-25.4]; P = .019). One man initially infected with N. gonorrhoeae multiantigen sequence type 2400 had type 4244 infection at day 14, indicating reinfection. CONCLUSIONS: 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. SN - 1537-6591 UR - https://www.unboundmedicine.com/medline/citation/25371490/Persistence_of_Neisseria_gonorrhoeae_DNA_following_treatment_for_pharyngeal_and_rectal_gonorrhea_is_influenced_by_antibiotic_susceptibility_and_reinfection_ L2 - https://academic.oup.com/cid/article-lookup/doi/10.1093/cid/ciu873 DB - PRIME DP - Unbound Medicine ER -