OBJECTIVE: Asymptomatic pharyngeal gonorrhoea could play an important role in transmission and should be screened for in persons at risk. We investigated the sensitivity of oral gargle samples to detect N. gonorrhoea and describe the frequency of infection by anatomical site.
METHODS: From June 2021 to July 2022 persons diagnosed with gonorrhoea in the STI/HIV department were asked to provide self-collected specimens for single-site testing by NAAT from throat (by gargling and swabbing), anorectum, and first-void urine.
RESULTS: 104 episodes of gonorrhoea were analysed in 88 individuals. The median age was 33 years, 85 persons (96.5%) were male. The pharynx was the most common site of infection (71 cases, 68.2%); in 26 persons (25.0%) it was the only site of infection. Anorectal infection was detected in 65 cases (62.5%) and urogenital infection in 25 cases (24.0%). In 46 cases (44.2%) infection was detected in more than one anatomical site. Gargling was less sensitive than throat swabbing to detect pharyngeal infection (85.9% versus 97.2%, p = .038), but was preferred by patients. Only 4 of 71 pharyngeal infections (5.6%) were symptomatic; anorectal and urogenital infections were symptomatic in 12.3% and 76.0% of cases, respectively. Culture recovery of N.gonorrhoeae was only possible in 15.8% of throat swabs, but was successful in 61.9% of anorectal and 84.2% of urogenital samples.
CONCLUSIONS: Asymptomatic pharyngeal gonorrhoea is common. Gargle samples should be used only as alternative specimens with inferior sensitivity compared to throat swab samples.

OBJECTIVE: To systematically review and synthesis the evidence of vaccine effectiveness (VE) and impact (VI) of meningococcal vaccines in preventing gonorrhoea.
METHODS: We systematically evaluated studies. Literature searches were conducted in PubMed, Embase, Cochrane Library, CINAHL, Google Scholar, clinical trial registries, and major health and immunisation conferences. Meta-analysis was performed with the DerSimonian-Laird random-effects model to estimate the pooled VE.
RESULTS: Twelve studies met the criteria for inclusion. VE of meningococcal B (MenB) outer membrane vesicle (OMV) vaccines was evaluated in nine studies, with one study evaluating a non-OMV vaccine, MenB-FHbp. The majority of studies targeted individuals aged 15-30 years. Adjusted VE for OMV vaccines against gonorrhoea ranged from 22% to 46%. MenB-FHbp did not show protection against gonorrhoea. The pooled VE estimates of OMV vaccines against any gonorrhoea infection following the full vaccine series were 33-34%. VI was assessed for 4CMenB in Canada and Australia, for VA-MENGOC-BC in Cuba; and for MenBvac in Norway. VI ranged from a 30% to 59% reduction in gonorrhoea incidence.
CONCLUSIONS: 4CMenB and other MenB-OMV vaccines show moderate effectiveness against gonorrhoea. Further research is required to explore the factors associated with vaccine protection, informing more effective vaccination strategies for the management of gonococcal infections.

UNASSIGNED: To address inequitable diagnostic access and improve time-to-treatment for First Nations peoples, molecular point-of-care (POC) testing for chlamydia, gonorrhoea and trichomonas was integrated into 49 primary care clinics across Australia. We conducted an observational evaluation to determine clinical effectiveness and analytical quality of POC testing delivered through this national program.
UNASSIGNED: We evaluated (i) implementation by measuring trends in mean monthly POC testing; ii) clinical effectiveness by comparing proportions of positive patients treated by historical control/intervention period and by test type, and calculated infectious days averted; (iii) analytical quality by calculating result concordance by test type, and proportion of unsuccessful POC tests.
UNASSIGNED: Between 2016 and 2022, 46,153 POC tests were performed; an increasing mean monthly testing trend was observed in the first four years (p < 0.0001). A greater proportion of chlamydia/gonorrhoea positives were treated in intervention compared with historical control periods (≤2 days: 37% vs 22% [RR 1.68; 95% CI 1.12, 2.53]; ≤7 days: 48% vs 30% [RR 1.6; 95% CI 1.10, 2.33]; ≤120 days: 79% vs 54% [RR 1.46; 95% CI 1.10, 1.95]); similarly for trichomonas positives and by test type. POC testing for chlamydia, gonorrhoea and trichomonas averted 4930, 5620 and 7075 infectious days, respectively. Results concordance was high [99.0% (chlamydia), 99.3% (gonorrhoea) and 98.9% (trichomonas)]; unsuccessful POC test proportion was 1.8% for chlamydia/gonorrhoea and 2.1% for trichomonas.
UNASSIGNED: Molecular POC testing was successfully integrated into primary care settings as part of a routinely implemented program achieving significant clinical benefits with high analytical quality. In addition to the individual health benefits of earlier treatment, fewer infective days could contribute to reduced transmissions in First Nations communities.
UNASSIGNED: This work was supported by an Australian National Health and Medical Research Council Partnership Grant (APP1092503), the Australian Government Department of Health, Western Australia and Queensland Departments of Health.

UNASSIGNED: Men who have sex with men (MSM) are more vulnerable to acquiring sexually transmitted infections (STIs). In 2019, for instance, 74% of European Neisseria gonorrhoeae (Ng) cases among males affected MSM. A recent report by the World Health Organization showed that most of the 2020\' interim targets to end STIs by 2030 had not been met. A broadened understanding of STI transmission networks could guide future elimination strategies and reduce the STI burden. Therefore, we used whole-genome sequencing (WGS) to determine Ng-clusters and assess sexual mixing.
UNASSIGNED: WGS was performed on Ng-isolates collected at the Medical University of Vienna, Austria and was used for core genome multi-locus sequencing typing cluster analysis. Epidemiologic and infection-specific details were extracted from medical records.
UNASSIGNED: Genomic analysis and demographic data were available for 415 isolates, and 43.9% (182/415) were allocated to 31 Ng-clusters. Nine clusters comprised samples from heterosexual individuals only (women N = 4, human immunodeficiency virus (HIV)-negative men N = 49, HIV-positive man N = 1), nine clusters included MSM only (HIV-negative N = 22, HIV-positive N = 13) and 13 clusters included both heterosexuals and MSM (HIV-negative N = 75, HIV-positive N = 18). Current use of HIV pre-exposure prophylaxis (PrEP) was reported by 22.8% of MSM. In multivariate analysis, only \'MSM\' predicted clustering with isolates from HIV-positive individuals (adjusted odds ratio 10.24 (95% CI 5.02-20.90)).
UNASSIGNED: Sexual mixing of HIV-positive, HIV-negative MSM and non-MSM was frequently observed. Furthermore, HIV-serodiscordant clustering highlights the importance of PrEP rollout to avert HIV transmission. Our findings can inform future STI prevention strategies and continuous surveillance efforts are required to keep up with transmission dynamics.

While ceftriaxone remains the first-line treatment for gonorrhoea, the US CDC recommended cefixime as a second-line treatment in 2021. We tested 1176 Neisseria gonorrhoeae isolates among clients attending the Melbourne Sexual Health Centre in 2021-2022. The prevalence of cefixime resistance was 6.3% (74/1176), azithromycin resistance was 4.9% (58/1176) and ceftriaxone resistance was 0% (0/1176). Cefixime resistance was the highest among women (16.4%, 10/61), followed by men-who-have-sex-with-women (6.4%, 7/109), and men-who-have-sex-with-men (5.8%, 57/982). The prevalence of cefixime-resistant N. gonorrhoeae exceeds the threshold of the 5% resistance level recommended by the World Health Organization; and thus, cefixime treatment would have limited benefits in Australia.

OBJECTIVE: To quantify the amount of unnecessary antibiotics, in particular ceftriaxone, given to men who have sex with men (MSM) with anogenital symptoms as part of presumptive management in an urban sexual health clinic and examine factors associated with unnecessary ceftriaxone.
METHODS: This is a retrospective cross-sectional analysis of electronic records from all visits involving MSM reporting symptoms of bacterial sexually transmitted infection (STI) and who received presumptive antibiotics at Sydney Sexual Health Centre. The following variables were extracted: demographic and sexual behaviour data, presenting symptoms, prior STI diagnoses, use of anoscopy, use of point-of-care microscopy, prescriptions of antibiotics and subsequent nucleic acid amplification testing (NAAT) results for chlamydia and gonorrhoea in all anatomical sites (urethra, pharynx and rectum). We defined unnecessary antibiotic as an agent prescribed to treat an STI organism that was subsequently not detected.
RESULTS: Among 1061 visits in this analysis, 41.8% yielded negative NAAT results for both chlamydia and gonorrhoea in all anatomical sites. There were 44.3% of visits which had positive gonorrhoea NAAT result in at least one anatomical site. There were 187 courses of ceftriaxone prescribed in patients who tested negative for gonorrhoea in all anatomical sites and therefore were unnecessary. Unnecessary ceftriaxone prescribing occurred in 50.2% of visits with anorectal symptoms, 19.6% of scrotal symptoms and 7.3% of urethral symptoms. Microscopy was associated with significantly less unnecessary ceftriaxone in urethral but not anorectal or scrotal presentations. In multivariable analysis, the following factors were associated with a higher likelihood of unnecessary ceftriaxone use: anorectal symptoms, scrotal symptoms, gonorrhoea in the preceding year, contact of a bacterial STI and living with HIV.
CONCLUSIONS: This study highlights the significant amount of unnecessary ceftriaxone used for STI symptoms in MSM. A new pathway incorporating rapid point-of-care molecular testing in symptomatic patients may improve the precision of antibiotic prescribing and reduce unnecessary use.

BACKGROUND: The incidence of gonorrhoea at the European level increased over 2012-2019, decreased in 2020, and then reached higher values in 2021 than in 2019.
OBJECTIVE: Analysis in the descriptive epidemiology scheme of gonorrhoea notification in surveillance in Poland in 2021 (being the second year of the COVID-19 pandemic).
METHODS: Case-base data from surveillance of gonorrhoea were used: confirmed case (meeting laboratory criteria), probable (meeting clinical criteria and contact with confirmed case) and possible (only in Poland - physician diagnosed gonorrhoea, no information available for proper classification). Statistic Poland data was used to calculate the indicators. Data on patients treated in dermatology-venereology clinics between 2019-2021 were taken from the Bulletins of the Ministry of Health.
RESULTS: The incidence of gonorrhoea in Poland in 2021 was only a fraction of recorded in the EU/EEA (0.74 vs. 13.7/100000)-similar to the first pandemic year and were about half of those notified in the 2019 (the peak year; 281 vs. 522 cases). There were 15.5 men per one female (incidence: 1.6/100000 men, 0.1/100000 women). Every second case was among aged 25-34 (49.62%), every fourth-aged 35-44 (23.11%). Under 15, no cases were reported. The predominant site was the genitourinary (excluding missing data: 85.3%). The cases with missing information on transmision increased (49.1%; aged 45+: 72.0%, women: 76.5%). Delays in reporting data were identified (greater than in 2019, however, less than in 2020), ~17% cases were from 2019-2020. Dermatology-venerology clinics treated 385 people - less than in 2020, however, more than reported in epidemiological surveillance (vs. 281).
CONCLUSIONS: The COVID-19 pandemic has influenced on the surveillance system in Poland. There are difficulties in interpreting the epidemiological trend. It is necessary to: 1) intensify systemic solutions in the area of prevention, including sexual partners; 2) raise the awareness of healthcare professionals and sanitary inspection workers on the role of collecting epidemiological information.
UNASSIGNED: Współczynnik zachorowalności na rzeżączkę na poziomie krajów europejskich wzrastał na przestrzeni lat 2012-2019, obniżył się w 2020, a następnie w 2021 osiągnął wyższe wartości niż w 2019.
UNASSIGNED: Analiza w schemacie epidemiologii opisowej przypadków rzeżączki, które wykazano w ramach nadzoru epidemiologicznego w Polsce w 2021 (będącym drugim rokiem trwania pandemii COVID-19).
UNASSIGNED: Wykorzystano jednostkowe dane z nadzoru epidemiologicznego nad rzeżączką: przypadek potwierdzony (spełnienie kryteriów laboratoryjnych), prawdopodobny (spełnienie kryteriów klinicznych oraz kontakt z przypadkiem potwierdzonym) oraz możliwy (stosowany jedynie w Polsce - lekarz rozpoznał rzeżączkę, brak informacji pozwalających na właściwą klasyfikację). Do wyliczenia wskaźników użyto danych GUS. Dane o leczonych w poradniach skórno-wenerologicznych w latach 2019-2021 zaczerpnięto z Biuletynów Ministerstwa Zdrowia.
UNASSIGNED: Zapadalność na rzeżączkę w Polsce w 2021 stanowiła zaledwie ułamek odnotowywanej w UE/EOG (0,74 vs 13,7/100000), wartości były zbliżone do pierwszego pandemicznego roku i stanowiły około połowy tych wykazanych w szczycie zachorowań z 2019 (281 vs. 522 przypadków). Na jedno zachorowanie kobiety przypadało 15,5 mężczyzn (zapadalność: 1,6/100000 mężczyzn, 0,1/100000 kobiet). Co drugi przypadek dotyczył osób w wieku 25-34 lat (49,62%), co czwarty – w wieku 35-44 lat (23,11%). Poniżej 15 roku życia nie zgłoszono zachorowań. Zdecydowana większość dotyczyła zakażenia dróg płciowo-moczowych (wyłączając braki danych: 85,3%). Wzrosła liczba zgłoszeń pomijająca informację o drodze zakażenia (49,1%; wśród osób w wieku 45+: 72,0%, wśród kobiet: 76,5%). Zidentyfikowano opóźnienia w przekazywaniu danych (większe niż w 2019, jednakże mniejsze niż w 2020), ~17% przypadków to rzeżączki z lat 2019-2020. Poradnie skórno-wenerologiczne leczyły 385 osób z rzeżączką - mniej niż w 2020, jednakże więcej niż przypadków wykazanych w nadzorze epidemiologicznym (vs. 281).
UNASSIGNED: Pandemia COVID-19 wpłynęła na system nadzoru w Polsce, co przełożyło się na utrudnienia w interpretacji trendu epidemiologicznego. Należy: 1) zintensyfikować systemowe rozwiązania w obszarze profilaktyki, w tym dla partnerów osób zakażonych; 2) podnieść świadomości pracowników ochrony zdrowia oraz inspekcji sanitarnej na temat istoty zbierania informacji epidemiologicznych.

Background: Neisseria gonorrhoeae is one of the most important causative organisms in causing sexually transmitted infections. The clinical presentation of gonorrhoea mimics the symptoms of other sexually transmitted infections, and a proper diagnosis of the same is therefore crucial in patient management. The current study intended to compare different in-house molecular methods: that is, conventional PCR, real-time PCR, and LAMP assay for detection of N. gonorrhoeae. Methods: A total of 163 samples were collected from 145 patients who presented with urethral and vaginal discharge. Collected samples were processed for culture on GC agar base, and three different molecular diagnostic tests (conventional PCR, real-time PCR, and LAMP assay) were performed simultaneously on all the samples. Results: Culture of N. gonorrhoeae was positive in 17 out of 21 (80.9%) swab samples. With culture as the gold standard method, conventional and real-time PCR had a sensitivity of 94.1%, whereas the sensitivity of the LAMP assay was found to be 88.2%. All three methods had a specificity of 100%. In addition to swab samples, evaluation of urine samples by different molecular methods yielded a good concordance with a kappa value of 0.85 by conventional PCR and real-time PCR showing a perfect level of agreement, while the LAMP assay was found to have a substantial level of agreement. Conclusion: LAMP assay had a comparable diagnostic accuracy to other molecular methods for the detection of N. gonorrhoeae and can be used as a point-of-care test in resource-limited settings.

OBJECTIVE: The utility of whole genome sequencing (WGS) to inform sexually transmitted infection (STI) patient management is unclear. Timely WGS data might support clinical management of STIs by characterising epidemiological links and antimicrobial resistance profiles. We conducted a systematic review of clinical application of WGS to any human pathogen that may be transposable to gonorrhoea.
METHODS: We searched six databases for articles published between 01/01/2010-06/02/2023 that reported on real/near real-time human pathogen WGS to inform clinical intervention. All article types from all settings were included. Findings were analysed using narrative synthesis.
RESULTS: We identified 12,179 articles, of which eight reported applications to inform tuberculosis (n = 7) and gonorrhoea (n = 1) clinical patient management. WGS data were successfully used as an adjunct to clinical and epidemiological data to enhance contact-tracing (n = 2), inform antimicrobial therapy (n = 5) and identify cross-contamination (n = 1). WGS identified gonorrhoea transmission chains that were not established via partner notification. Future applications could include insights into pathogen exposure detected within sexual networks for targeted patient management.
CONCLUSIONS: While there was some evidence of WGS use to provide individualised tuberculosis and gonorrhoea treatment, the eight identified studies contained few participants. Future research should focus on testing WGS intervention effectiveness and examining ethical considerations of STI WGS use.

Two recently published randomized trials of doxycycline post exposure prophylaxis (PEP) have concluded that this intervention is highly effective at reducing the incidence of bacterial sexually transmitted infections (STIs) and has little or no risk of promoting the spread of antimicrobial resistance (AMR). In this perspective piece, we review four types of evidence that suggest that the risk of promoting AMR has been inadequately assessed in these studies. 1) The studies have all used proportion resistant as the outcome measure. This is a less sensitive measure of resistogenicity than MIC distribution. 2) These RCTs have not considered population-level pathways of AMR selection. 3) In populations with very high antimicrobial consumption such as PrEP cohorts, the relationship between antimicrobial consumption and resistance may be saturated. 4) Genetic linkage of AMR means that increased tetracycline use may select for AMR to not only tetracyclines but also other antimicrobials in STIs and other bacterial species. We recommend novel study designs to more adequately assess the AMR-inducing risk of doxycycline PEP.