Neisseria gonorrhoeae infection in urban Sydney women: prevalence and predictors.
BACKGROUND
The notification rate of female gonorrhoea in urban Sydney is very low. With the increasing use of nucleic acid amplification tests (NAAT), demonstrating a low prevalence of gonorrhoea in women would have important implications for the reliability of positive results. We determined the prevalence of female cervical gonorrhoea in our urban sexual health clinic and identified associated clinical, behavioural and demographic variables that may allow more targeted screening practices.


METHODS
The Sydney Sexual Health Centre database was used to identify women tested for cervical gonorrhoea between 1997 and 2007. Diagnostic, demographic and behavioural information were extracted to ascertain the prevalence of gonorrhoea and describe variables associated with infection. Additionally, a case control study was conducted of cervical gonorrhoea cases from January 2000 to December 2005, with two gonorrhoea negative women selected for each case as controls. A blinded researcher examined each medical record to determine genital symptoms, being a contact of gonorrhoea, sex work, sex outside of Australia, injecting drug use.


RESULTS
Between 1997 and 2007, 77 women were diagnosed with cervical gonorrhoea, a prevalence of 0.37%. Results of the case control study reveal that women with gonorrhoea were more likely to be symptomatic [odds ratio (OR) 3.7, 95% confidence interval (CI) 1.7-8.4], be a known contact of gonorrhoea (OR 264, 95% CI 149-470), or have had recent sex overseas, or with a partner from overseas (OR 1.75, 95% CI 1.11-2.75).


CONCLUSIONS
Cervical gonorrhoea infection is rare in our urban sexual health clinic, and even more unlikely in asymptomatic women without risk factors. This low prevalence of gonorrhoea, particularly in asymptomatic women, decreases the reliability of positive NAAT test results. This has important implications for the screening of asymptomatic women presenting to urban sexual health clinics in Australia.
McDonagh
Paula
P
Sydney Sexual Health Centre, Sydney Hospital, GPO Box 1614, Sydney, NSW 2001, Australia.
Ryder
Nathan
N
McNulty
Anna M
AM
Freedman
Eleanor
E
D000328:Adult; D016022:Case-Control Studies; D016001:Confidence Intervals; D005260:Female; D006069:Gonorrhea / Q000175:diagnosis* / Q000453:epidemiology*; D006801:Humans; D008875:Middle Aged; D009344:Neisseria gonorrhoeae / Q000302:isolation & purification*; D009517:New South Wales / Q000453:epidemiology; D021141:Nucleic Acid Amplification Techniques / Q000379:methods; D016017:Odds Ratio; D011237:Predictive Value of Tests; D015995:Prevalence; D012307:Risk Factors; D014505:Urban Population / Q000706:statistics & numerical data*; D016387:Women's Health; D055815:Young Adult