A. Lynam* **, M. Quinlan**, S. Clarke* **, L. Pomeroy**, M. Kelleher***, B. Crowley***, F. Cooney****, F. Lyons* on behalf of the Gonorrhoea control group *Department of Genitourinary Medicine and Infectious Diseases, St. James’s Hospital, Dublin 8 **Gay Men’s Health Project, Baggott Street Hospital, Dublin 2 ***Department of Microbiology, Clinical Pathology Laboratory, St. James’s Hospital, Dublin 8 **** Dept. of Public Health, HSE East, Dr Steevens’ Hospital, Dublin 8.

Introduction A gonorrhoea control group was convened by Public Health, HSE East in December 2012 in response to an increase in reported cases

Introduction Enhanced surveillance of cases Q1 2013, increased awareness amongst HCPs and public awareness campaign

Introduction A significant proportion of reported cases had positive gonorrhoea NAAT from the pharyngeal site only Patients rarely report pharyngeal symptoms

Introduction – GC diagnostics Abbott Real-Time CT/NG PCR System introduced in September 2010 Target: Multiplex PCR for C. trachomatis targeting 2 x Cryptic plasmid DNA + Pumpkin gene (IC) +/-N. gonorrhoeae opacity (Opa) gene All reactive samples are confirmed on an in house PCR – por A, sufficiently divergent* *In line with BASHH guidelines

Introduction – GC diagnostics Prior to September 2010, routinely used GC culture  Very sensitive to drying Use a transport medium  Fastidious organism Selective media New York City media or chocolate with antibiotic supplement blood/serum, growth factors (iron, haemin, coenzyme NAD) Warm plates before inoculation Capnophilic: prefer increased levels CO 2 (5-10%), 35-37°C Sensitivity: up to 85%

Culture positive obviously replicating organisms – are NAAT positive samples representative of replicating organisms?

Objectives Determine the spontaneous clearance (as determined by NAAT) of pharyngeal GC in patients with positive GC NAAT at pharyngeal site only Determine the proportion of pharyngeal GC positive NAATs that are culture positive Examine factors associated with clearance/persistence

Methods In line with current guidelines all patients with positive GC NAAT are recalled for GC culture from site of positive NAAT Treatment (ceftriaxone 500mg IM + azithromycin PO*) Partner notification Arrangements made for test of cure Between April and September 2014, individuals with a positive NAAT at pharyngeal only site Usual care Repeat NAAT and culture taken at time of recall, prior to treatment *azithromycin at 1 or 2g PO

Results April to September individuals were identified Initial screen gonorrhoea positive at pharyngeal site only AND A second screen was taken prior to treatment All Male Asymptomatic screens Median age 28 years (range years) 58/63(82.1%) HIV negative

Results *not applicable 1 st screen2 nd screen NAAT culture Positive6340/4928/63 NegativeNA*9/4935/63 Not performed NA*140 Culture positive in 28/63 22 NAAT positive 6 did not have NAAT repeated NAAT negative 9/49 All culture negative

Results Second screen NAAT positive 40/49(82%), 95% CI NAAT negative 9/49 (18%), 95% CI Culture positive 28/63(44%), 95% CI Culture negative 35/63(56%), 95% CI

Results Median time between screens (days): 7 (range 5 – 33) NAAT negative/culture negative (7, 7-23) NAAT positive/culture negative (7, 5-15) NAAT positive/culture positive (7, 7-27)

Conclusion In this small study 18% individuals were negative on repeat NAAT prior to treatment 56% individuals were culture negative prior to treatment Further work is needed to better understand the clinical significance of positive GC NAAT when found at the pharyngeal site only