title: Gonorrhoea Diagnostic and Treatment Uncertainties: Risk Factors for Culture Negative Confirmation after Positive Nucleic Acid Amplification Tests.
abstract: Gonorrhoea incidence has increased substantially in Stockholm during the past years. These increases have coincided with changes in testing practice from solely culture-based to nucleic acid amplification tests (NAAT). Gonorrhoea NAAT is integrated with Chlamydia trachomatis testing and due to opportunistic screening for chlamydia, testing prevalence for gonorrhoea has increased substantially in the Stockholm population. The aim of this study was to examine epidemiological risk-factors for discordant case which are NAAT positive but culture negative. These discordant cases are especially problematic as they give rise to diagnostic and treatment uncertainties with risk for subsequent sequelae. All gonorrhoea cases from Stockholm county during 2011-2012 with at least one positive N. gonorrhoea NAAT test and follow-up cultures were included (N = 874). Data were analysed using multivariate and stratified logistic regression models. Results showed that women were 4-times more likely (OR 4.9; 95% CI 2.4-6.7) than men to have discordant cultures. Individuals tested for gonorrhoea without symptoms were 2.3 times more likely (95% CI 1.5-3.5) than those with symptoms to be discordant. NAAT method and having one week or more between NAAT and culture testing were also indicative of an increased likelihood for discordance. Using NAAT should be based on proper clinical or epidemiological indications and, when positive, followed-up with a culture-based test within one week if possible. Routine gonorrhoea testing is not recommended in low prevalence populations.
authors.affiliation: Department of Communicable Disease Control and Prevention, Stockholm County, Stockholm, Sweden.
authors.forename: Rebecka
authors.initials: R
authors.lastname: Vyth
authors.affiliation: Department of Communicable Disease Control and Prevention, Stockholm County, Stockholm, Sweden.|Department of Medicine, Infectious Disease Unit, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Amy
authors.initials: A
authors.lastname: Leval
authors.affiliation: Department of Communicable Disease Control and Prevention, Stockholm County, Stockholm, Sweden.|Department of Medicine, Infectious Disease Unit, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Björn
authors.initials: B
authors.lastname: Eriksson
authors.affiliation: Division of Clinical Microbiology, Karolinska University Hospital, Huddinge, Stockholm, Sweden.
authors.forename: Eva-Lena
authors.initials: EL
authors.lastname: Ericson
authors.affiliation: Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden.
authors.forename: Lena
authors.initials: L
authors.lastname: Marions
authors.affiliation: Department of Communicable Disease Control and Prevention, Stockholm County, Stockholm, Sweden.|Department of Medicine, Infectious Disease Unit, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Maria-Pia
authors.initials: MP
authors.lastname: Hergens
mesh_terms: D000328:Adult; D015331:Cohort Studies; D005260:Female; D006069:Gonorrhea / Q000175:diagnosis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D021141:Nucleic Acid Amplification Techniques / Q000379:methods*; D012307:Risk Factors; D035501:Uncertainty; D055815:Young Adult