The Centers for Disease Control and Prevention 2015 Sexually Transmitted Disease Treatment Guidelines recommend that clinicians consider cephalosporin treatment failure in patients who deny interval sexual exposure and are nucleic acid amplification test (NAAT) positive for Neisseria gonorrhoeae (NG) at least 7 days after adequate treatment. We evaluate the real-world implications of the interval the Centers for Disease Control and Prevention recommends for a NAAT test-of-cure (TOC), by ascertaining the frequency of NG NAAT positivity at different anatomic sites among men who have sex with men (MSM) at TOC 7 to 30 days after treatment.
We analyzed data from the medical records of MSM with laboratory-confirmed NG who were presumptively treated for NG during the period from June 2013 to April 2016 and returned for a TOC visit within 30 days. Data examined included symptoms, site of NG specimen collection, treatment regimen, follow-up testing, and intervening sexual activity.
There were 1027 NG-positive specimens obtained from 763 MSM patients at 889 presumptive treatment visits. Of these, 44% (337/763) MSM returned for 1 or more TOC visits, and 413 specimens were collected a median of 10 days after presumptive treatment. Three percent (14/413) of specimens collected were NG NAAT positive at TOC a median of 13 days after treatment: 5% (12/256) of urethral specimens, 1% (1/147) of anorectal specimens (P = 0.037, urethral vs. anorectal), and 10% (1/10) of oropharyngeal specimens (P = 0.40, urethral vs. oropharyngeal).
A small percent of patients were NG NAAT positive at TOC. Compared with anorectal specimens, urethral specimens were more frequently still positive at TOC. A large proportion of MSM will return for a TOC visit as part of standard clinical care.
At a test-of-cure visit at least 7 days after treatment, Neisseria gonorrhoeae was detected by nucleic acid amplification in a larger proportion of patients with initial urethral versus anorectal infection.
From the *Icahn School of Medicine at Mount Sinai; †New York City Department of Health and Mental Hygiene, New York, NY; and ‡Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA
Conflict of Interest and Sources of Funding: The authors do not have any conflicts of interest, financial or otherwise, to disclose. Ebiere Okah received a stipend from the New York City Department of Health and Mental Hygiene during the time this work was conducted.
Centers for Disease Control and Prevention (CDC) Disclaimer: The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the US CDC. Mention of company names or products does not imply endorsement by the CDC.
Correspondence: Julia A. Schillinger, MD, MSc, Bureau of Sexually Transmitted Disease Control, New York City, Department of Health and Mental Hygiene, CN#73, 42-09 28th Street, New York, NY 11101. E-mail: firstname.lastname@example.org.
Received for publication January 31, 2017, and accepted August 19, 2017.