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

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: Melanie Bissessor, David M Whiley, Christopher K Fairley, Catriona S Bradshaw, David M Lee, Anthony S Snow, Monica M Lahra, Jane S Hocking, Marcus Y Chen
• Journal: Clinical infectious diseases : an official publication of the Infectious Diseases Society of America (Clin Infect Dis) Vol. 60 Issue 4 Pg. 557-63 (Feb 15 2015) ISSN: 1537-6591 [Electronic] United States
• PMID: 25371490 (Publication Type: Journal Article)
• Copyright: © The Author 2014. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: [email protected].

Chemical References

• Anti-Bacterial Agents
• Bacterial Outer Membrane Proteins
• Porins
• porin protein, Neisseria
• Opa protein, Neisseria
• Ceftriaxone
• Azithromycin
• DNA

Topics

• Adult
• Anti-Bacterial Agents (therapeutic use)
• Azithromycin (therapeutic use)
• Bacterial Load
• Bacterial Outer Membrane Proteins (genetics)
• Ceftriaxone (therapeutic use)
• DNA (isolation & purification)
• Gonorrhea (drug therapy, microbiology)
• Humans
• Male
• Microbial Sensitivity Tests
• Middle Aged
• Neisseria gonorrhoeae (genetics, isolation & purification)
• Nucleic Acid Amplification Techniques
• Pharyngeal Diseases (drug therapy, microbiology)
• Pharynx (microbiology)
• Porins (genetics)
• Real-Time Polymerase Chain Reaction
• Rectal Diseases (drug therapy, microbiology)
• Rectum (microbiology)
• Young Adult