Department of Sexual Health, Infectious Diseases, and Environmental Health, South Limburg Public Health Service, Heerlen, The Netherlands.
Department of Medical Microbiology, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands.
Clin Infect Dis. 2020 Aug 14;71(4):944-951. doi: 10.1093/cid/ciz964.
Most oropharyngeal Neisseria gonorrhoeae infections are asymptomatic, and many infections remain undetected, creating a reservoir for ongoing transmission and potential drug resistance. It is unclear what the optimal testing policy is in men who have sex with men (MSM), as routine universal testing data are lacking.
Surveillance data from all Dutch sexually transmitted infection (STI) clinics between 2008 and 2017 were used (N = 271 242 consultations). Oropharyngeal testing policy was defined as routine universal testing when ≥85% of consultations included oropharyngeal testing or as selective testing (<85% tested). Independent risk factors for oropharyngeal N. gonorrhoeae were assessed among MSM routinely universally screened using backward multivariable logistic regression analyses.
Routine universal testing was performed in 90% (238 619/265 127) of consultations. Prevalence was higher using routine universal testing (5.5%; 95% CI, 5.4-5.6; 12 769/233 476) than with selective testing (4.7%; 95% CI, 4.4-5.0; 799/17 079; P < .001). Proportions of oropharyngeal-only infections were 55% and 47%, respectively. Independent risk factors were age <31 years (OR, 2.1; 95% CI, 1.9-2.3), age 31-43 years (OR, 1.7; 95% CI, 1.6-1.9, compared with >43 years), being notified for any STI (OR, 2.0; 95% CI, 1.9-2.1), concurrent urogenital N. gonorrhoeae (OR, 2.4; 95% CI, 2.1-2.7), and concurrent anorectal N. gonorrhoeae (OR, 11.4; 95% CI, 10.6-12.3). When using any of the risk factors age, notified, or oral sex as testing indicators, 98.4% (81 022/82 332) of MSM would be tested, finding 99.5% (4814/4838) of infections.
Routine universal testing detected more oropharyngeal N. gonorrhoeae infections than selective testing, of which more than half would be oropharyngeal only. Using independent risk factors as testing indicator is not specific. Therefore, routine universal oropharyngeal testing in MSM is feasible and warranted, as currently advised in most guidelines.
大多数口咽型淋病奈瑟菌感染是无症状的，许多感染仍未被发现，这为持续传播和潜在的耐药性创造了潜在的感染源。目前尚不清楚在男男性行为者（MSM）中最佳的检测策略是什么，因为缺乏常规的普遍检测数据。
利用 2008 年至 2017 年所有荷兰性传播感染（STI）诊所的监测数据（N=271242 次就诊）。当≥85%的就诊者接受口咽检测时，将口咽检测政策定义为常规普遍检测，否则为选择性检测（＜85%的就诊者接受检测）。采用多变量逻辑回归分析，对常规普遍筛查的 MSM 中口咽淋病奈瑟菌的独立危险因素进行评估。
90%（238619/265127）的就诊者进行了常规普遍检测。与选择性检测（4.7%；95%CI，4.4-5.0；799/17079）相比，常规普遍检测的患病率更高（5.5%；95%CI，5.4-5.6；12769/233476；P＜0.001）。口咽型感染的比例分别为 55%和 47%。独立的危险因素为年龄＜31 岁（OR，2.1；95%CI，1.9-2.3），31-43 岁（OR，1.7；95%CI，1.6-1.9，与＞43 岁相比），通知任何性传播感染（OR，2.0；95%CI，1.9-2.1），并发泌尿生殖道淋病奈瑟菌（OR，2.4；95%CI，2.1-2.7），并发肛门直肠淋病奈瑟菌（OR，11.4；95%CI，10.6-12.3）。当使用年龄、通知或口交作为检测指标中的任何一个危险因素时，98.4%（81022/82332）的 MSM 将接受检测，发现 99.5%（4814/4838）的感染。
与选择性检测相比，常规普遍检测检测到更多的口咽型淋病奈瑟菌感染，其中超过一半为口咽型感染。使用独立的危险因素作为检测指标并不具有特异性。因此，目前大多数指南建议，对 MSM 进行常规普遍的口咽检测是可行且必要的。
