![[ Visit Client Website ]](images/banner.gif)
Background: The 2015 CDC STD Treatment Guidelines recommend clinicians consider treatment failure if patients remain nucleic acid amplification test (NAAT) positive for Neisseria gonorrhea (NG) >=7 days after adequate treatment. To monitor for treatment failure, two New York City STD clinics ask men-who-have-sex-with-men (MSM) diagnosed with laboratory-confirmed NG to return for a NAAT test-of-cure (TOC) 7 days later. This project ascertained the duration of NG NAAT positivity.
Methods: We analyzed data from the medical records of MSM with laboratory-confirmed NG who were presumptively treated for NG during June 2013-December 2015 and returned for a first TOC (TOC1) within 30 days. Data examined included symptoms, site of NG specimen collection, sexual activity, treatment regimens, and follow-up testing.
Results: Among 781 NG infected MSM, 42% (326/781) returned within one month. Return rates were higher among patients who were: > age 30 (51% (129/255) versus 37% (197/526) <= age 30), HIV-negative (46% (211/455)) versus 36% (79/217) HIV-positive) and other than non-Hispanic black (47% (191/407) versus 36% (135/374) non-Hispanic black. Only 4% (13/307) of returning patients tested NG-positive by NAAT TOC1 >=7 days after treatment (median 13 days); 6% of urethral (12/187), 1% of anorectal (1/89) (p=0.0674). None (0/31) remained NG-positive at both sites. Seven of the 13 NG-positive patients denied intervening sex and were asymptomatic. All 7 were NG-positive at the urethra; 3 were NG-negative by a second TOC (TOC2) 5, 7, and 8 days following TOC1; 2 remained NG-positive by TOC2 6 days following TOC1; 2 did not return for TOC2. Of the 2 who remained NG-positive at TOC2, 1 had elevated minimum inhibitory concentrations of azithromycin (1 ug/mL) at initial diagnosis, but was treated with azithromycin 2g.
Conclusions: Few patients were NG NAAT-positive at TOC. Our data suggest that urethral NG infection may take longer to clear than anorectal infection.