Twisk Denise E, Klaassen Corné, van Westreenen Mireille, Götz Hannelore M
Department of Public Health, Public Health Service (GGD) Rotterdam-Rijnmond, Rotterdam, Netherlands
Department of Public Health, Erasmus MC, Rotterdam, Netherlands.
Sex Transm Infect. 2025 Mar 24;101(2):109-116. doi: 10.1136/sextrans-2024-056313.
Sexual health centres (SHCs) in the Netherlands report a surge in gonorrhoea, especially among young women (notably oropharyngeal) and men who have sex with women (MSW) since the second half of 2022. MSW are not routinely oropharyngeal tested, and women only when reporting oral sex. This cross-sectional study aimed to assess oropharyngeal gonorrhoea in MSW and women, and potential underdiagnosis.
From 10 August to 10 November 2023, the SHC in Rotterdam, the Netherlands, extended its gonorrhoea testing protocol, requiring oropharyngeal tests for all MSW and women. Positive cobas nucleic acid amplification test (NAAT) results were followed by culture sampling. Oropharyngeal infections were confirmed with a second NAAT (opa gene-based PCR), and for discrepancies a third NAAT (GeneXpert CT/NG test) was employed. The impact of extended testing on detection rates, along with the corresponding 95% CIs, was analysed.
The overall gonorrhoea detection rate was 6.4% (95% CI 4.7% to 8.8%) among MSW and 6.0% (95% CI 4.8% to 7.6%) among women, compared with 3.6% (95% CI 2.3% to 5.4%) and 6.0% (95% CI 4.8% to 7.6%) without expanded testing. Oropharyngeal rates were 6.4% (95% CI 4.4% to 9.2%) for MSW and 4.3% (95% CI 3.2% to 5.7%) for women. Highest positivity was among individuals notified, <25 years, without migratory background, with lower educational levels and more sex partners. Oropharyngeal cultures confirmed viable gonorrhoea in 39.1% of MSW and 35.5% of women. False positives were 7.4% among MSW and 10.8% among women. Confirmed oropharyngeal gonorrhoea positivity rate was 5.9% (95% CI 4.0% to 8.6%) among MSW and 3.9% (95% CI 2.8% to 5.2%) among women.
Oropharyngeal gonorrhoea is common and currently underdiagnosed among MSW. The impact of this underdiagnosis on transmission dynamics under the current testing policy remains unclear. Further research is needed to inform prevention and control strategies, especially given the recent surge in gonorrhoea.
荷兰的性健康中心报告称，自2022年下半年以来，淋病病例激增，尤其是在年轻女性（尤其是口咽部感染）和与女性发生性行为的男性中。与女性发生性行为的男性通常不进行口咽部检测，而女性只有在报告有口交行为时才会接受检测。这项横断面研究旨在评估与女性发生性行为的男性和女性中的口咽部淋病情况以及潜在的诊断不足问题。
2023年8月10日至11月10日，荷兰鹿特丹的性健康中心扩大了淋病检测方案，要求对所有与女性发生性行为的男性和女性进行口咽部检测。cobas核酸扩增检测（NAAT）结果呈阳性后进行培养采样。口咽部感染通过第二次NAAT（基于opa基因的PCR）进行确认，对于结果不一致的情况则采用第三次NAAT（GeneXpert CT/NG检测）。分析了扩大检测对检出率的影响以及相应的95%置信区间。
与未扩大检测时相比，与女性发生性行为的男性中淋病总体检出率为6.4%（95%置信区间4.7%至8.8%），女性中为6.0%（95%置信区间4.8%至7.6%），未扩大检测时分别为3.6%（95%置信区间2.3%至5.4%）和6.0%（95%置信区间4.8%至7.6%）。与女性发生性行为的男性口咽部淋病检出率为6.4%（95%置信区间4.4%至9.2%），女性为4.3%（95%置信区间3.2%至5.7%）。阳性率最高的是那些被通报的、年龄小于25岁、无移民背景、教育水平较低且性伴侣较多的个体。口咽部培养证实39.1%的与女性发生性行为的男性和35.5%的女性存在活的淋病奈瑟菌。与女性发生性行为的男性假阳性率为7.4%，女性为10.8%。经确认的口咽部淋病阳性率在与女性发生性行为的男性中为5.9%（95%置信区间4.0%至8.6%），女性中为3.9%（95%置信区间2.8%至5.2%）。
口咽部淋病很常见，目前在与女性发生性行为的男性中存在诊断不足的情况。在当前检测政策下，这种诊断不足对传播动态的影响尚不清楚。需要进一步研究以指导预防和控制策略，尤其是考虑到近期淋病病例的激增。
