Department of Medical Microbiology and Infectious Diseases, Erasmus MC, Rotterdam, Zuid-Holland, The Netherlands.
Public Health Service, Department of Infectious Disease Control, Rotterdam City Council, Rotterdam, Zuid-Holland, The Netherlands
Sex Transm Infect. 2022 Mar;98(2):121-124. doi: 10.1136/sextrans-2020-054525. Epub 2021 Feb 25.
European guidelines advise the use of dual nucleic acid amplification tests (NAAT) in order to minimise the inappropriate diagnosis of (Ng) in urogenital samples from low prevalence areas and in extragenital specimens. In this cross-sectional study, we investigated the effect of confirmatory testing and confirmation policy on the Ng-positivity in a population visiting the sexual health clinic in Rotterdam, the Netherlands.
Apart from urogenital testing, extragenital (oropharyngeal/anorectal) testing was performed for men who have sex with men (MSM) and according to sexual exposure for women and heterosexual men. Ng detection using NAAT was performed using BD Viper and for confirmatory testing BD MAX. Sexual transmitted infection consultation data were merged with diagnostic data from August 2015 through May 2016.
In women (n=4175), oral testing was performed in 84% and 22% were tested anally. In MSM (n=1828), these percentages were 97% and 96%, respectively. Heterosexual men (n=3089) were tested urogenitally. After confirmatory testing, oropharyngeal positivity rates decreased from 7.3% (95% CI 6.5 to 8.2) to 1.5% (95% CI 1.1 to 1.8) in women and from 13.9% (95% CI 12.3 to 15.5) to 5.4% (95% CI 4.3 to 6.4) in MSM. Anorectal positivity rates decreased from 2.6% (95% CI 1.6 to 3.7) to 1.8% (95% CI 0.9 to 2.6) in women and from 9.3% (95% CI 7.9 to 10.7) to 7.2% (95% CI 6.0 to 8.5) in MSM. Urogenital Ng-positivity rate ranged between 3.0% and 4.4% and after confirmation between 2.3% and 3.9%. When confirming oropharyngeal samples, Ng-positivity was 3.8% in women, 3.0% in heterosexual men and 12.5% in MSM. Additional confirmation of urogenital and anorectal samples led to 3.0% Ng positivity in women, 2.7% in heterosexual men and 11.4% in MSM.
Confirmation of urogenital and anorectal samples reduced the Ng-positivity rates, especially for women. However, as there is no gold standard for the confirmation of Ng infection, the dilemma within public health settings is to choose between two evils: missing diagnoses or overtreatment. In view of the large decrease in oropharyngeal positivity, confirmation Ng-positivity in oropharyngeal samples remains essential to avoid unnecessary treatment.
欧洲指南建议使用双重核酸扩增检测（NAAT），以尽量减少在低流行地区泌尿生殖道标本和外生殖道标本中对（Ng）的不适当诊断。在这项横断面研究中，我们研究了在荷兰鹿特丹性健康诊所就诊的人群中，确认性检测和确认政策对 Ng 阳性率的影响。
除泌尿生殖道检测外，还对男男性行为者（MSM）进行了外生殖道（口咽/肛门直肠）检测，并根据女性和异性恋男性的性暴露情况进行了检测。使用 BD Viper 进行 Ng 的 NAAT 检测，使用 BD MAX 进行确认性检测。性传播感染咨询数据与 2015 年 8 月至 2016 年 5 月的诊断数据合并。
在女性（n=4175）中，84%进行了口腔检测，22%进行了肛门直肠检测。在 MSM（n=1828）中，这些百分比分别为 97%和 96%。异性恋男性（n=3089）进行了泌尿生殖道检测。在进行确认性检测后，女性的口咽阳性率从 7.3%（95%CI 6.5 至 8.2）降至 1.5%（95%CI 1.1 至 1.8），MSM 的口咽阳性率从 13.9%（95%CI 12.3 至 15.5）降至 5.4%（95%CI 4.3 至 6.4）。女性的肛门直肠阳性率从 2.6%（95%CI 1.6 至 3.7）降至 1.8%（95%CI 0.9 至 2.6），MSM 的肛门直肠阳性率从 9.3%（95%CI 7.9 至 10.7）降至 7.2%（95%CI 6.0 至 8.5）。泌尿生殖道 Ng 阳性率在 3.0%至 4.4%之间，确认后在 2.3%至 3.9%之间。当确认口咽样本时，女性的 Ng 阳性率为 3.8%，异性恋男性为 3.0%，MSM 为 12.5%。对泌尿生殖道和肛门直肠样本的进一步确认导致女性的 Ng 阳性率为 3.0%，异性恋男性为 2.7%，MSM 为 11.4%。
确认泌尿生殖道和肛门直肠样本降低了 Ng 阳性率，特别是对女性而言。然而，由于没有 Ng 感染的金标准，公共卫生部门的困境是在两种恶之间做出选择：漏诊或过度治疗。鉴于口咽部位的阳性率显著下降，对口咽样本进行确认性 Ng 阳性检测对于避免不必要的治疗仍然至关重要。
