%0 Journal Article
%T Pharyngeal Gonorrhoea in Women: An Important Reservoir for Increasing Neisseria gonorrhoea Prevalence in Urban Australian Heterosexuals?
%A M. Josephine Lusk
%A Ruby N. N. Uddin
%A Monica M. Lahra
%A Frances L. Garden
%A Ratan L. Kundu
%A Pam Konecny
%J Journal of Sexually Transmitted Diseases
%D 2013
%I Hindawi Publishing Corporation
%R 10.1155/2013/967471
%X We aim to characterize sexual behavioral aspects of heterosexual Neisseria gonorrhoea (NG) acquisition in two Sexually Transmitted Diseases clinics in Sydney, Australia, in 2008¨C2012. Of 167 NG cases, 102 were heterosexually acquired with a trend of increasing NG prevalence in heterosexuals from 1.1% (95% CI 0.6¨C2.1) in 2008 to 3.0% (95% CI 2.0¨C4.0) in 2012 ( ). Of heterosexual male cases, unprotected fellatio was the likely sexual activity for NG acquisition in 21/69 (30.4%) and commercial sex work (CSW) contact the likely source in 28/69 (40.6%). NG prevalence overall in CSW (2.2%) was not significantly higher than in non-CSW (1.2%) ( ), but in 2012 there was a significant increase in NG prevalence in CSW (8.6%) compared to non-CSW (1.6%) ( ). Pharyngeal NG was found in 9/33 (27.3%) female cases. Decreased susceptibility to ceftriaxone (MIC ¡Ý 0.03£¿mg/L) occurred in 2.5% NG isolates, none heterosexually acquired. All were azithromycin susceptible. A significant trend of increasing prevalence of heterosexual gonorrhoea in an urban Australian STD clinic setting is reported. We advocate maintenance of NG screening in women, including pharyngeal screening in all women with partner change who report fellatio, as pharyngeal NG may be an important reservoir for heterosexual transmission. Outreach to CSW should be enhanced. 1. Introduction Latest surveillance indicates rising rates of Neisseria gonorrhoea (NG) in New South Wales, Australia [1]. The risk of HIV transmission is significantly enhanced by coinfection with NG [2, 3], and so the control of NG particularly in light of increasing minimum inhibitory concentration (MIC) values to ceftriaxone is a major public health concern [4, 5]. The predominance of gonorrhoea amongst Australian urban men who have sex with men (MSM) is well documented [1, 6] but heterosexual gonorrhoea in urban settings is less well characterised. NG is a notifiable disease in Australia but data is only collected by age, sex, and region of diagnosis and so heterosexual trends are poorly defined. Trends of increasing prevalence of heterosexually acquired NG and acquisition from fellatio and commercial sex worker (CSW) contact were noted in our suburban STD services in 2009, prompting this investigation specifically aimed at examining sexual behavioral aspects of heterosexual NG acquisition. 2. Methods A case series was conducted from patient records at two STD services in South Eastern Sydney over a 5-year period, January 1, 2008 to December 31, 2012. Data was collected prospectively from late 2009 when the study started but
%U http://www.hindawi.com/journals/jstd/2013/967471/