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Clinical presentation of asymptomatic and symptomatic women who tested positive for genital gonorrhoea at a sexual health service in Melbourne, Australia

Published online by Cambridge University Press:  28 September 2020

Mario Martín-Sánchez*
Affiliation:
Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia Preventive Medicine and Public Health Training Unit PSMar-UPF-ASPB, Barcelona, Spain
Christopher K. Fairley
Affiliation:
Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia Central Clinical School, Monash University, Melbourne, VIC, Australia
Jason J. Ong
Affiliation:
Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia Central Clinical School, Monash University, Melbourne, VIC, Australia
Kate Maddaford
Affiliation:
Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia
Marcus Y. Chen
Affiliation:
Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia Central Clinical School, Monash University, Melbourne, VIC, Australia
Deborah A. Williamson
Affiliation:
Department of Microbiology and Immunology, Microbiological Diagnostic Unit Public Health Laboratory, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
Catriona S. Bradshaw
Affiliation:
Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia Central Clinical School, Monash University, Melbourne, VIC, Australia
Eric P.F. Chow
Affiliation:
Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia Central Clinical School, Monash University, Melbourne, VIC, Australia Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
*
Author for correspondence: Mario Martín-Sánchez, E-mail: mario.martin04@estudiant.upf.edu
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Abstract

Gonorrhoea cases in women have been rising in Australia in the 2010s but the cause of the increase is not well understood. This cross-sectional study aimed to describe the characteristics of genital gonorrhoea infection in women attending the Melbourne Sexual Health Centre, Australia. Gonorrhoea cases were diagnosed by nucleic acid amplification test (NAAT) and/or culture. Genitourinary specimens were obtained in 12 869 clinic visits in women aged 16 years or above between August 2017 and August 2018. Genital gonorrhoea was detected in 142 (1.1%) of the visits. Almost half of the cases were asymptomatic, 47.9% [95% confidence interval (CI) 39.8–56.1%]; yellow, green or pus-like vaginal discharge was present in 11.3% (95% CI 7.0–17.6%) and other genital symptoms in 40.8% (95% CI 33.1–49.1%) of the cases. The mean time between last sexual contact and onset of symptoms was 7.3 days and between the onset of symptoms to presentation to the clinic was 12.1 days. Half of the cases of genital gonorrhoea among women are asymptomatic and these cases would have been missed by testing of only symptomatic women. Further epidemiological and behavioural research is required to understand the temporal changes in sexual practices among women in Australia.

Type
Original Paper
Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Copyright
Copyright © The Author(s), 2020. Published by Cambridge University Press

1. Introduction

It is considered that the current epidemic of gonorrhoea mainly affects men, particularly gay, bisexual and other men who have sex with men (MSM) in Australia [Reference Chow, Grulich and Fairley1, Reference Jasek2]. Gonorrhoea is deemed to be uncommon among women in major Australian cities (<1% in the population); however rises have been observed in the 2010s [Reference Misson3Reference Chow5]. This increase has also been reported among women in other high-income countries such as England, Spain or the USA [6Reference Savage10]. The rise in gonorrhoea cases has also been observed in MSM and heterosexual men [Reference Phillips11]. Overall, there was an 80% increase in the notification rate of gonorrhoea (from 65.5 to 118.0 per 100 000) between 2013 and 2017 in the total Australian population.

The reasons underlying the rise in gonorrhoea among women remain unclear. While the Australian Study of Health and Relationships surveys reported there was no change in condomless penile-vaginal sex nor in the number of sexual partners among women between 2001 and 2013 [Reference Rissel12, Reference De Visser13], trend data on sexual practices among Australian women thereafter is scarce and other factors (e.g. sex overseas, use of smartphone dating applications) may have changed over time and contributed to the rise of gonorrhoea [Reference Misson3, Reference Aung14Reference Sundbeck, Agardh and Östergren16]. Other reasons besides sexual practices may include sociodemographic changes or changes in health services use. The increase in health care demand from the rising rates of sexually transmitted infections (STIs) may be making it harder to access health care, and consequently increasing the duration of untreated infection which would lead to ongoing transmission [Reference Needleman17Reference Foley19].

Genital gonorrhoea can be asymptomatic in women and, hence individuals may not be aware of their infection for long periods. Untreated gonorrhoea in women can lead to pelvic inflammatory diseases and other serious complications including ectopic pregnancy or infertility [Reference Walker and Sweet20], making prompt identification and treatment especially important. However, recent studies on genital gonorrhoea symptomatology in women are very limited and most studies were conducted in the 1970s and culture was used for gonorrhoea diagnosis in these studies [Reference Pedersen and Bonin21Reference Wallin23].

Accordingly, the primary aim of this study was to estimate the proportion of genital gonorrhoea cases that were asymptomatic and symptomatic among women attending a sexual health clinic in Melbourne in Australia using nucleic acid amplification test (NAAT). The secondary aim was to describe the time from the last sexual contact to the onset of symptoms and the time to attend health care following the onset of symptoms to determine if these offered any insights into reasons for the recent increases in the infection rates and consequently, to potential public health interventions.

2. Methods

2.1 Study population

This was a cross-sectional study including all women aged 16 years or above attending the Melbourne Sexual Health Centre (MSHC), Australia, between August 2017 and August 2018. MSHC is a public HIV/STI clinic that offers a range of free clinical services regarding sexual health. MSHC is the largest sexual health clinic in Victoria and provides more than 50 000 clinical consultations a year. For the purposes of this study, only cisgender women were included.

Prior to August 2017, as genital gonorrhoea was considered very uncommon in female attendees, testing was only recommended among women who reported genital symptoms (i.e. presence of discharge or dysuria) or sexual contact with someone diagnosed with gonorrhoea infection as per the Australian STI Management Guidelines [24]. However, MSHC implemented an in-house screening policy in August 2017, and all women attending MSHC, regardless of the presence of symptoms, were offered genital gonorrhoea and chlamydia screening by NAAT using Aptima Combo (AC2) assay (Hologic Panther system; Hologic, San Diego, CA, USA) [Reference Johnson25, 26]. All clients attending MSHC were asked if they had any symptoms by the triage nurse and then by the treating clinician. Symptomatic women were examined by the clinician and an endocervical swab was obtained for NAAT and/or culture for Neisseria gonorrhoeae. No examination was performed among asymptomatic women [Reference Lee27], but they were asked to self-collect a vaginal swab or first pass urine (FPU) and the specimens were tested by NAAT for N. gonorrhoeae. If a swab was collected for culture, it was plated immediately onto modified Thayer-Martin medium for gonorrhoea culture and a smear prepared for Gram stain and microscopy to look for Gram negative diplococci. For individuals who tested positive by NAAT but had no culture performed at the screening visit, a culture test was performed on the subsequent visit before gonorrhoea treatment was administered, to determine the antimicrobial susceptibility profile.

2.2 Data collection

We collected data regarding demographic characteristics, recent sexual practices, sex work, self-reported genital symptoms and duration, sexual contact with a person diagnosed with gonorrhoea, investigations performed and laboratory results. For the purpose of this study, we categorised gonorrhoea cases among women into two groups based on their reported symptoms: (i) symptomatic; or (ii) asymptomatic. Symptomatic cases were defined as women who had any genital symptoms on the day of testing. Symptomatic cases included not only women with a characteristic discharge for gonorrhoea (yellow, green or pus-like vaginal discharge) but also reporting other genital symptoms such as dysuria, urethral discomfort, vulvar or vaginal itch, clear abnormal vaginal discharge or lower abdominal pain. Asymptomatic cases were women who reported no genitourinary symptoms on the day of testing.

2.3 Data analysis

Descriptive analyses were conducted to summarise the key parameters. The 95% confidence intervals (CIs) for the sample proportions were calculated using Agresti-Coull (adjusted Wald) method. All analyses were conducted using SPSS (version 25, Armonk, NY: IBM Corp). Ethical approval was granted by the Alfred Hospital Ethics Committee, Melbourne, Australia (450/18).

3. Results

There were 17 258 clinic visits by 9302 individual women attending MSHC during the study period. Genitourinary specimens were obtained (FPU, endocervical or vaginal specimens) in 12 869 (74.6%) clinic visits from 7350 individual women. Genital gonorrhoea was detected in 1.1% (142/12 869) of the clinic visits where women were tested for genital gonorrhoea, corresponding to 142 different gonorrhoea cases in 140 individual women. The investigations performed including NAAT and culture for N. gonorrhoeae are shown in Figure 1. The median age of the 142 genital gonorrhoea cases was 28 years [interquartile range (IQR) 24–34], 79 (55.6%) were born overseas and 13 (9.2%) had a previous gonorrhoea diagnosis at the MSHC. The median number of male sexual partners in the preceding three months was 2 (IQR 1–4) and 12 (8.5%) reported having a female sexual partners in the preceding three months. Only 12 (8.5%) reported always using condoms with male partners for sex in the preceding three months, 37 (26.1%) reported having sex overseas in the preceding 12 months and 52 (36.6%) were currently working as sex workers (Table 1).

Fig. 1. Investigations performed in 142 cases of genital N. gonorrhoeae infection among women attending MSHC, 2017–2018.

*33 (73.3%) cases were symptomatic, including eight cases with yellow, green or pus-like vaginal discharge, 12 (26.7%) were asymptomatic.

In four cases only culture was performed as it was previously diagnosed outside MSHC.

56 (57.7%) were asymptomatic, 41 (42.3%) had genital symptoms including eight cases with yellow, green or pus-like vaginal discharge.

Of the 56 cases with a negative culture in a subsequent visit, 10 (17.9%) had received antibiotic treatment on the first visit (five received treatment for bacterial vaginosis, two for urinary tract infection, two for chlamydia and one for both chlamydia and bacterial vaginosis); among the ones with positive cultures, four (22.2%) had received antibiotic treatment (three for bacterial vaginosis and one for urinary tract infection).

NAAT, nucleic acid amplification test; MSHC, Melbourne Sexual Health Centre.

Table 1. Demographic and sexual behaviour characteristics of 142 cases of genital N. gonorrhoeae infection among women attending MSHC, 2017–2018

IQR: interquartile range. Data are presented as either n (%) or median (IQR).

*The median of male sex partners was calculated among 103 women who reported the number of male partners, excluding the 39 women who decided not to report the number of male partners in the preceding three months.

‘Not always’ was defined as women who sometimes, usually or never used a condom with their male partners in the preceding 3 months.

Chi-squared test was used to compare categorical variables between symptomatic and asymptomatic women. Mann-Whitney U test was used to compare continuous variables between symptomatic and asymptomatic women.

Almost half of the cases (n = 68, 47.9%, 95% CI 39.8–56.1%) reported no symptoms (Table 2). Of the 74 cases (52.1%, 95% CI 44.0–60.1%) where women reported any symptom, the most common symptoms reported included a clear abnormal vaginal discharge (n = 29, 39.2%), dysuria (n = 23, 31.1%) and a change in vaginal discharge to a yellow, green or pus-like vaginal discharge (n = 16, 21.6%; 11.3% [95% CI 7.0–17.6%] over the total number of cases). A smaller proportion also reported Per Vaginal (PV)/postcoital bleeding (n = 9; 12.2%) and pelvic pain (n = 8; 10.8%) (Table 3). Among the 142 genital gonorrhoea cases, 18 (12.7%) had concurrent bacterial vaginosis and 11 (7.7%) had pelvic inflammatory disease. Of the 25 (17.6%) cases with sexual contact with a male diagnosed with gonorrhoea, 13 (52.0%) were asymptomatic, and 12 (48.0%) symptomatic, including three cases with yellow, green or pus-like vaginal discharge.

Table 2. Clinical characteristics of cases of genital N. gonorrhoeae infection among women attending MSHC, 2017–2018

CI, confidence interval; SD, standard deviation; NAAT, nucleic acid amplification test.

*10 and 60 women reported date of last sexual contact and date of onset of symptoms, respectively. The denominator of the percentage is the total of specimens in which the investigation was performed.

Table 3. Symptoms present on the day of testing among 74 symptomatic cases of genital N. gonorrhoeae infection among women attending MSHC, 2017–2018

*There were cases in which more than one symptom was present

There were 10 symptomatic women who reported the date of last sexual contact, and the mean time between last sexual contact and the onset of symptoms was 7.3 days [standard deviation (SD) 4.4, ranging from 2 to 16 days]. In addition, there were 60 symptomatic women who reported the date of symptom onset, and the mean time between the onset of symptoms and presentation to the clinic was 12.1 days (SD 14.6, ranging from 1 to 90 days) (Table 2). Among these 60 symptomatic women, 22 (36.7%) presented to the clinic up to 5 days after symptoms onset, 16 (26.7%) between 6 and 10 days and 22 (36.7%) after 10 days or more.

Of the 142 cases with genital gonorrhoea, 135 were also tested for genital chlamydia and 18 (13.3%) tested positive for genital chlamydia by NAAT. Among 68 asymptomatic cases, the positivity for genital chlamydia was 13.6% and among symptomatic was 13.0% (Table 2).

4. Discussion

In this clinical audit of 142 confirmed genital gonorrhoea cases in women attending a sexual health clinic in Melbourne, we found that 48% of the cases among women did not have any reported genital symptoms on the day of testing, and only an 11% had typical N. gonorrhoeae discharge (i.e. yellow, green or pus-like vaginal discharge). This suggests that a substantial proportion of asymptomatic cases would have been missed without screening of asymptomatic women. This result also contrasts with heterosexual men where more than 90% of genital cases are symptomatic [Reference Martín-Sánchez28]. Along similar lines, time from symptoms onset to presentation to the clinic was of 12 days, which could be partially explained by the non-specific symptoms of gonorrhoea. Given the importance of the early detection of infectious cases for effective gonorrhoea control, it is possible that a public health campaign aimed at increasing awareness and knowledge on gonorrhoea, as well as, improving testing of gonorrhoea in symptomatic women and asymptomatic women at risk may be indicated.

There are some limitations in the study that should be noted. First, this study was conducted in one urban major public sexual health clinic in Melbourne that sees only 25% of the cases of gonorrhoea diagnosed in women. Our data may therefore not be representative of presentations to general practice [Reference Williamson29]. Women in our study may be biased towards to those with genital symptoms or contacts of infection. Besides that, sex workers may be overrepresented in our study for the mandatory three-monthly HIV/STI screening [Reference Chow30]. Second, recall bias might have occurred when women reported the time between the onset of symptoms and last sexual contact. Moreover, a substantial proportion of data was missing because it was not always systematically collected, hence we could only present the results of the time between last sexual contact and the onset of symptoms when the data is available. Third, sexual health services in Melbourne are quite limited and it is not always possible to see all individuals on the day that they present symptoms [Reference Needleman17]. This could have contributed to more than five days elapsed since symptoms onset to presentation to the clinic in almost two-thirds of the cases. It is therefore possible that the time between the onset of symptoms and presentation may be longer in our study than for women attending other services.

There have been very limited studies estimating the proportion of gonorrhoea in women that is asymptomatic and most of these studies were conducted in the 1970s. Asymptomatic screening in women is not currently recommended in many countries such as the USA and UK. In addition, clinical diagnosis of gonorrhoea in symptomatic women is always difficult because the presence of non-specific symptoms (e.g. dysuria, dyspareunia, vulvar itch or pelvic pain) may be confounded by other infections such as bacterial vaginosis, Chlamydia trachomatis and Trichomonas vaginalis. In our study, we found that 48% of women who tested positive for N. gonorrhoeae did not report any genital symptoms on the day of screening. However, McCormack and colleagues reviewed 278 women with gonorrhoea in 1974 in Boston in a hospital setting and they found that only 19% of the cases were asymptomatic [Reference McCormack31]. Furthermore, we found that 52% (13/25) of gonorrhoea contacts that tested positive for genital gonorrhoea were asymptomatic. Our previous audit in 2017–18 showed 44% (26/59) of asymptomatic female gonorrhoea contacts tested positive by NAAT at the genital site [Reference Chow32]. However, Pariser and colleagues (1968) found that only 29% of asymptomatic female gonorrhoea contacts were culture-positive for gonorrhoea [Reference Pariser and Farmer33]. The low positivity in Pariser and colleagues’ study may be due to poor sensitivity in culture compared to NAAT. Past studies have shown that the majority of women with gonorrhoea would develop symptoms within 9–11 days after sexual exposure and this is similar to the estimate of 7.3 days in our study [Reference Platt, Rice and McCormack22, Reference Wallin23].

The increase in the rates of gonorrhoea among women in Australia has happened alongside an increase in the incidence of chlamydia and infectious syphilis since the mid-2010s [Reference Jasek2, 34, 35]. This has also led to the re-emergence of congenital syphilis in Victoria in 2017, which has not emerged in the state since 2004 [34, 35]. The Australian national surveys have revealed that there were no significant changes in the number of partners and condomless sex among women in Australia between 2001 and 2013 [Reference Phillips11, Reference Rissel12]; however, the much of the STI rise occurs after 2013, and there have been very limited behavioural studies examining sexual practices among women in Australia. The rises in gonorrhoea in women in Australia remain unclear and it may be due to other unmeasured factors (e.g. group sex, use of smartphone dating applications, transmission from higher-incidence populations) that may have changed over time. Nevertheless, given the importance of access to health care for the control of STIs, public health campaigns and sexual health educations are important to increase the awareness and recognition of STI-related symptoms. General practitioners should also be informed and trained accordingly to increase the knowledge and awareness of the current STI epidemic, testing and treatment guidelines.

In conclusion, genital gonorrhoea is largely asymptomatic or has an unspecific clinical presentation among women. Testing only women with typical N. gonorrhoeae discharge would have missed a considerable number of cases. Further efforts must be made to promote gonorrhoea screening at primary care settings in Victoria, including training on test and treat among general practitioners. Additionally, epidemiological and behavioural research is required to understand the temporal changes in sexual practices among women in Australia and how this could be related to recent increases in the incidence of gonorrhoea.

Acknowledgements

The authors acknowledge Afrizal Afrizal for his assistance with data extraction at the Melbourne Sexual Health Centre.

Funding

CKF and CSB are supported by an Australian National Health and Medical Research Council (NHMRC) Leadership Investigator Grant (GNT1172900 and GNT1173361, respectively). DAW and EPFC are supported by an Australian NHMRC Emerging Leadership Investigator Grant (GNT1174555 and GNT1172873, respectively).

Conflicts of interest/Competing interests

The authors declare that they have no conflict of interest.

Ethics approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the granted by the Alfred Hospital Ethics Committee, Melbourne, Australia (450/18). This study was an analysis of retrospective data collected from a clinical service. Informed consent is not required as per the ethical approval of this study.

Data Availability Statement

All relevant data generated or analysed during this study are included in this published article.

References

Chow, EPF, Grulich, AE and Fairley, CK (2019) Epidemiology and prevention of sexually transmitted infections in men who have sex with men at risk of HIV. The Lancet HIV Elsevier Ltd 6, e396e405.CrossRefGoogle ScholarPubMed
Jasek, E, et al. (2017) Sexually Transmitted Infections in Melbourne, Australia from 1918 to 2016: nearly a century of data. Communicable Diseases Intelligence Quarterly Report 41, E212E222.Google ScholarPubMed
Misson, J, et al. (2018) Trends in gonorrhoea infection and overseas sexual contacts among females attending a sexual health centre in Melbourne, Australia, 2008–2015. Communicable Diseases Intelligence 2018, 42.Google Scholar
Chow, EPF, et al. (2019) Prevalence of genital and oropharyngeal chlamydia and gonorrhoea among female sex workers in Melbourne, Australia, 2015–2017: Need for oropharyngeal testing. Sexually Transmitted Infections 95, 398401. Published online: 2019.CrossRefGoogle ScholarPubMed
Chow, EPF, et al. (2015) Gonorrhoea notifications and nucleic acid amplification testing in a very low-prevalence Australian female population. Medical Journal of Australia 202, 321323. Published online: 2015.CrossRefGoogle Scholar
Public Health England (2019) Sexually transmitted infections and chlamydia screening in England, 2018. Health Protection Report 13, 19, Published online: 2019.Google Scholar
Sentís, A, et al. (2019) Sexually transmitted infections in young people and factors associated with HIV coinfection: An observational study in a large city. BMJ Open 9, e027245, Published online: 2019.CrossRefGoogle Scholar
European Centre for Disease Prevention and Control (2019) Gonorrhoea. In: ECDC. Annual epidemiological report for 2017. Stockholm: ECDC.Google Scholar
Centers for Disease Control. Sexually Transmitted Disease Surveillance 2018. Centre of Disease Control and Prevention 2018. Published online: 2018. doi: 10.1016/j.molmet.2013.04.004.CrossRefGoogle Scholar
Savage, EJ, et al. (2012) Rapid increase in gonorrhoea and syphilis diagnoses in England in 2011. Eurosurveillance 17, 20224. doi: 10.2807/ese.17.29.20224-en.Google ScholarPubMed
Phillips, TR, et al. (2019) Risk factors for urethral gonorrhoea infection among heterosexual males in Melbourne, Australia: 2007–17. Sexual Health 16, 508513. Published online: 2019.CrossRefGoogle ScholarPubMed
Rissel, C, et al. (2014) Heterosexual experience and recent heterosexual encounters among Australian adults: The second Australian study of health and relationships. Sexual Health 11, 416426. Published online: 2014.CrossRefGoogle ScholarPubMed
De Visser, RO, et al. (2003) Sex in Australia: Heterosexual experience and recent heterosexual encounters among a representative sample of adults. Australian and New Zealand Journal of Public Health 27, 146154. Published online: 2003.CrossRefGoogle ScholarPubMed
Aung, ET, et al. (2019) International travel as risk factor for Chlamydia trachomatis infections among young heterosexuals attending a sexual health clinic in Melbourne, Australia, 2007 to 2017. Eurosurveillance 24, 1900219. Published online: 2019.CrossRefGoogle Scholar
Cabada, MM, et al. (2009) High prevalence of sexually transmitted infections among young peruvians who have sexual intercourse with foreign travelers in Cuzco. Journal of Travel Medicine 16, 299303. Publishedo online: 2009.CrossRefGoogle ScholarPubMed
Sundbeck, M, Agardh, A and Östergren, PO. (2017) Travel abroad increases sexual health risk-taking among Swedish youth: A population-based study using a case-crossover strategy. Global Health Action 10, 1330511. Published online: 2017.CrossRefGoogle ScholarPubMed
Needleman, R, et al. (2018) Access to sexual health services after the rapid roll out of the launch of pre-exposure prophylaxis for HIV in Melbourne, Australia: A retrospective cross-sectional analysis. Sexual Health 15, 528532. Published online:2018.CrossRefGoogle ScholarPubMed
Dyer, C. (2014) Doctors warn local authorities about putting sexual health services out to tender. BMJ (Clinical research ed.) 348, f7715. Published online: 2014.Google ScholarPubMed
Foley, E, et al. (2017) Inequalities in access to genitourinary medicine clinics in the UK: Results from a mystery shopper survey. Sexually Transmitted Infections 93, 472475. Published online: 2017.CrossRefGoogle ScholarPubMed
Walker, CK and Sweet, RL (2011) Gonorrhea infection in women: Prevalence, effects, screening, and management. International Journal of Women's Health 3, 197206.Google Scholar
Pedersen, A and Bonin, P (1971) Screening females for asymptomatic gonorrhea infection. Northwest Med 70, 255–61.Google ScholarPubMed
Platt, R, Rice, PA and McCormack, WM (1983) Risk of Acquiring Gonorrhea and Prevalence of Abnormal Adnexal Findings Among Women Recently Exposed to Gonorrhea. JAMA: The Journal of the American Medical Association 250, 32053209. Published online: 1983.CrossRefGoogle ScholarPubMed
Wallin, J (1975) Gonorrhoea in 1972. A 1 year study of patients attending the VD unit in Uppsala. British Journal of Venereal Diseases 51, 41.Google ScholarPubMed
The Australian Government (2019) Department of Health. Australian STI management guidelines for use in primary care. Gonorrhoea. (http://www.sti.guidelines.org.au/sexually-transmissible-infections/gonorrhoea#diagnosis). Accessed 14 February 2020.Google Scholar
Johnson, RE, et al. (2002) Screening tests to detect Chlamydia trachomatis and Neisseria gonorrhoeae infections--2002. MMWR. Recommendations and Reports : Morbidity and Mortality Weekly Report. Recommendations and Reports/Centers for Disease Control 51, 138. doi: 10.1097/00019048-200206000-00018.Google Scholar
CDC (Centers for Disease Control and Prevention), et al. (2014) Recommendations for the Laboratory-Based Detection of Chlamydia trachomatis and Neisseria gonorrhoeae - 2014. Morbidity and Mortality Weekly Report 63, 119.Google Scholar
Lee, DM, et al. (2006) Is routine vaginal examination necessary for asymptomatic women attending sexual health services? International Journal of STD and AIDS 17, 631632. Published online: 2006.CrossRefGoogle ScholarPubMed
Martín-Sánchez, M, et al. (2020) Clinical presentation of asymptomatic and symptomatic heterosexual men who tested positive for urethral gonorrhoea at a sexual health clinic in Melbourne, Australia. BMC Infect Dis 20, 486. doi: 10.1186/s12879-020-05197-y.CrossRefGoogle Scholar
Williamson, DA, et al. (2019) Bridging of Neisseria gonorrhoeae lineages across sexual networks in the HIV pre-exposure prophylaxis era. Nature Communications Springer US 10, 110. Published online 2019.Google ScholarPubMed
Chow, EPF, et al. (2014) Testing commercial sex workers for sexually transmitted infections in Victoria, Australia: an evaluation of the impact of reducing the frequency of testing. PLoS One 9, e103081. Published online: 2014.CrossRefGoogle Scholar
McCormack, WM, et al. (1977) Clinical spectrum of gonococcal infection in women. The Lancet 309, 11821185.CrossRefGoogle Scholar
Chow, EPF, et al. (2019) Oropharyngeal and Genital Gonorrhea Infections Among Women and Heterosexual Men Reporting Sexual Contact With Partners With Gonorrhea: Implication for Oropharyngeal Testing of Heterosexual Gonorrhea Contacts. Sexually transmitted diseases 46, 743747. Published online: 2019.CrossRefGoogle ScholarPubMed
Pariser, H and Farmer, AD (1968) Diagnosis of gonorrhea in the asymptomatic female: Comparison of slide and culture technics. Southern Medical Journal 61, 505506.CrossRefGoogle ScholarPubMed
Kirby Institute (2018) Annual surveillance report 2018 HIV, viral hepatitis and sexually transmissible infections in Australia. Available at: https://kirby.unsw.edu.au/sites/default/files/kirby/report/KI_Annual-Surveillance-Report-2018_0.pdf.Google Scholar
Department of Health & Human Services, State Government of Victoria (2019) Syphilis cases continue to rise in Victoria in both men and women. [online] Available at: https://www2.health.vic.gov.au/about/news-and-events/healthalerts/rising-syphilis-cases-.Google Scholar
Figure 0

Fig. 1. Investigations performed in 142 cases of genital N. gonorrhoeae infection among women attending MSHC, 2017–2018.*33 (73.3%) cases were symptomatic, including eight cases with yellow, green or pus-like vaginal discharge, 12 (26.7%) were asymptomatic.In four cases only culture was performed as it was previously diagnosed outside MSHC.56 (57.7%) were asymptomatic, 41 (42.3%) had genital symptoms including eight cases with yellow, green or pus-like vaginal discharge.Of the 56 cases with a negative culture in a subsequent visit, 10 (17.9%) had received antibiotic treatment on the first visit (five received treatment for bacterial vaginosis, two for urinary tract infection, two for chlamydia and one for both chlamydia and bacterial vaginosis); among the ones with positive cultures, four (22.2%) had received antibiotic treatment (three for bacterial vaginosis and one for urinary tract infection).NAAT, nucleic acid amplification test; MSHC, Melbourne Sexual Health Centre.

Figure 1

Table 1. Demographic and sexual behaviour characteristics of 142 cases of genital N. gonorrhoeae infection among women attending MSHC, 2017–2018

Figure 2

Table 2. Clinical characteristics of cases of genital N. gonorrhoeae infection among women attending MSHC, 2017–2018

Figure 3

Table 3. Symptoms present on the day of testing among 74 symptomatic cases of genital N. gonorrhoeae infection among women attending MSHC, 2017–2018