title: Gonorrhoea notifications and nucleic acid amplification testing in a very low-prevalence Australian female population.
abstract: OBJECTIVE
  To examine whether the rapid increase of gonorrhoea notifications in Victoria, Australia, identified by nucleic acid amplification test (NAAT) is supported by similar changes in diagnoses by culture, which has higher specificity, and to determine the proportion of tests positive among women tested.
  
  
  METHODS
  Retrospective analysis of Medicare reporting of dual NAATs in Victoria, Victorian Department of Health gonorrhoea notifications, and gonorrhoea culture data at the Melbourne Sexual Health Centre (MSHC), among women, 2008 to 2013.
  
  
  METHODS
  Gonorrhoea notifications and testing methods.
  
  
  RESULTS
  Gonorrhoea cases identified by NAAT increased from 98 to 343 cases over the study period. Notifications by culture alone decreased from 19 to five cases. The proportion of NAATs positive for gonorrhoea in Victoria was low (0.2%-0.3%) and did not change over time (P for trend, 0.66). Similarly, the proportion of women tested at the MSHC for gonorrhoea who tested positive (0.4%-0.6%) did not change over time (P for trend, 0.70). Of untreated women who had a positive NAAT result for gonorrhoea and were referred to the MSHC, 10/25 were confirmed by culture.
  
  
  CONCLUSIONS
  The positivity of gonorrhoea in women identified by culture remains stable over time. Using NAAT for gonorrhoea screening in low-prevalence populations will result in many false positives. Positive NAAT results among low-risk women should be regarded as doubtful, and confirmatory cultures should be performed.
authors.affiliation: Melbourne Sexual Health Centre, Melbourne, VIC, Australia. echow@mshc.org.au.
authors.forename: Eric P F
authors.initials: EP
authors.lastname: Chow
authors.affiliation: Melbourne Sexual Health Centre, Melbourne, VIC, Australia.
authors.forename: Glenda
authors.initials: G
authors.lastname: Fehler
authors.affiliation: Melbourne Sexual Health Centre, Melbourne, VIC, Australia.
authors.forename: Tim R H
authors.initials: TR
authors.lastname: Read
authors.affiliation: Royal Women's Hospital Melbourne, Melbourne, VIC, Australia.
authors.forename: Sepehr N
authors.initials: SN
authors.lastname: Tabrizi
authors.affiliation: University of Melbourne, Melbourne, VIC, Australia.
authors.forename: Jane S
authors.initials: JS
authors.lastname: Hocking
authors.affiliation: Melbourne Sexual Health Centre, Melbourne, VIC, Australia.
authors.forename: Ian
authors.initials: I
authors.lastname: Denham
authors.affiliation: Melbourne Sexual Health Centre, Melbourne, VIC, Australia.
authors.forename: Catriona S
authors.initials: CS
authors.lastname: Bradshaw
authors.affiliation: Melbourne Sexual Health Centre, Melbourne, VIC, Australia.
authors.forename: Marcus Y
authors.initials: MY
authors.lastname: Chen
authors.affiliation: Melbourne Sexual Health Centre, Melbourne, VIC, Australia.
authors.forename: Christopher K
authors.initials: CK
authors.lastname: Fairley
mesh_terms: D000328:Adult; D001315:Australia / Q000453:epidemiology; D001431:Bacteriological Techniques / Q000379:methods; D002689:Chlamydia / Q000302:isolation & purification*; D002690:Chlamydia Infections / Q000175:diagnosis* / Q000453:epidemiology; D005260:Female; D006069:Gonorrhea / Q000175:diagnosis* / Q000453:epidemiology; D006801:Humans; D009344:Neisseria gonorrhoeae / Q000302:isolation & purification*; D021141:Nucleic Acid Amplification Techniques / Q000379:methods*; D011159:Population Surveillance; D011237:Predictive Value of Tests; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D060386:Sex Workers / Q000706:statistics & numerical data; D014739:Victoria / Q000453:epidemiology