High Prevalence of Oropharyngeal Neisseria Gonorrhea Infections Detected By Nucleic Acid Amplification Testing Among Men Who Have Sex with Men Attending New York City Sexually Transmitted Disease Clinics, 2013

Background: Nucleic Acid Amplification Testing (NAAT) is the most sensitive method of detecting Neisseria gonorrhea (GC) infections. Few laboratories are validated to perform GC NAAT on oropharyngeal (OP) specimens; however, evidence suggests a substantial burden of OP GC infections among men who have sex with men (MSM) contributing to ongoing transmission.

Methods: During April 2013, in addition to routinely collected urethral and anorectal specimens, OP specimens for GC NAAT and culture were collected from MSM reporting oral sex attending three sexually transmitted disease clinics in New York City (NYC). OP NAAT was performed by commercial assay at a validated laboratory; urethral and anorectal NAAT and all cultures were performed at the NYC DOHMH Public Health Laboratory.

Results: The prevalence of OP GC infection among MSM who reported performing oral sex was 12.4% (56/451). The vast majority (95%; 53/56) were asymptomatic. Prevalence was significantly higher among MSM <25 years compared to those ages 25 - 39 and >40 (25% vs 12% vs 3.8%, p<0.001), and MSM who reported sex with a GC infected partner (24% vs 11% among non-contacts, p=0.02). Although not statistically significant, HIV-positive MSM were less likely to have on OP GC infection than HIV-negative MSM (5.5% vs 13.8%). Among 233 MSM tested for GC at all three anatomic sites, 42 had GC infection at any site; 12/42 (29%) were positive only at the OP.  No OP GC infections were detected by culture among the 451 MSM tested by NAAT.

Conclusions: Using NAAT to test OP specimens for GC detects a high number of infections that would otherwise go undiagnosed. The high prevalence among young MSM who report performing oral sex suggests that this group may benefit from regular screening.