Sexual Health Unit, Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia.
Sexual Health Unit, Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia
Sex Transm Infect. 2022 Mar;98(2):139-141. doi: 10.1136/sextrans-2020-054690. Epub 2021 Feb 1.
In a previous study of men attending Melbourne Sexual Health Centre who had detected by urine Aptima Combo 2 (AC2) testing, 11% were asymptomatic. This study aimed to determine whether can be cultured from asymptomatic men screening positive for by nucleic acid amplification testing (NAAT) of urine.
Between 1 July 2017 and 31 March 2019, all men attending Melbourne Sexual Health Centre were tested for by AC2 testing of urine whether urethral symptoms were reported or not. NAAT-positive men were recalled and a urethral swab performed for gonococcal culture using modified Thayer-Martin media with determination of minimum inhibitory concentrations (MICs) by agar dilution.
There were 1001 cases (860 individuals) positive for by urine AC2: 892 (89%) reported urethral symptoms; 109 (11%) did not. Twenty-five asymptomatic cases were excluded because of antibiotic use at or following screening. Of the remaining 84 asymptomatic men, 41 (49%) had a urethral swab performed a median of 5 days after screening. Twenty-one men had urethral discharge at the return visit, 11 of whom reported the discharge at the return visit. Of the 41 men who were swabbed, 31 (76%; 95% CI 60% to 88%) were culture positive for . Among the 21 men who subsequently developed discharge, 19 (90%; 95% CI 70% to 99%) were culture positive. Among the 20 men who remained asymptomatic, 12 (60%; 95% CI 36% to 81%) were culture positive. MIC profiles were obtained from all isolates.
Gonorrhoea was isolated in most but not all asymptomatic men screening positive for by urine NAAT. Clinicians should consider performing urethral culture in such men to ensure optimal surveillance for antimicrobial resistance. Isolation of by culture in men without discharge indicates these are true infections with viable organisms.
在之前一项研究中，对在墨尔本性健康中心就诊且通过尿液 Aptima Combo 2（AC2）检测查出的男性进行了研究，发现其中 11%为无症状感染者。本研究旨在确定通过核酸扩增试验（NAAT）检测尿液中查出的 阳性的无症状男性，能否从他们身上培养出 。
2017 年 7 月 1 日至 2019 年 3 月 31 日期间，所有在墨尔本性健康中心就诊的男性，无论是否出现尿道症状，均接受 AC2 检测尿液中的 。对 NAAT 阳性的男性进行召回，并对尿道拭子进行淋病奈瑟菌培养，采用改良 Thayer-Martin 培养基，通过琼脂稀释法测定最低抑菌浓度（MIC）。
有 1001 例（860 人）尿液 AC2 检测出 阳性：892 例（89%）报告有尿道症状；109 例（11%）无症状。因筛查时或之后使用抗生素，25 例无症状病例被排除在外。在其余 84 例无症状男性中，41 例（49%）在筛查后中位数 5 天进行了尿道拭子检查。在复诊时，有 21 例男性出现尿道分泌物，其中 11 例在复诊时报告有分泌物。在进行拭子检查的 41 例男性中，31 例（76%；95%CI60%88%）培养出 。在随后出现分泌物的 21 例男性中，19 例（90%；95%CI70%99%）培养出 。在 20 例无症状的男性中，12 例（60%；95%CI36%~81%）培养出 。从所有分离株中获得 MIC 谱。
在通过尿液 NAAT 检测查出的大多数（但非全部）无症状 阳性男性中分离出了淋病奈瑟菌。临床医生应考虑对这类男性进行尿道培养，以确保对耐药性进行最佳监测。在无分泌物的男性中培养出 表明这些是真正的感染，存在有活力的病原体。
