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Journal of Clinical Microbiology, April 2009, p. 902-907, Vol. 47, No. 4
0095-1137/09/$08.00+0     doi:10.1128/JCM.01581-08
Copyright © 2009, American Society for Microbiology. All Rights Reserved.

Nucleic Acid Amplification Tests for Diagnosis of Neisseria gonorrhoeae Oropharyngeal Infections{triangledown}

Laura H. Bachmann,1,2,5* Robert E. Johnson,4 Hong Cheng,2 Lauri E. Markowitz,4 John R. Papp,4 and Edward W. Hook III1,2,3

University of Alabama at Birmingham School of Medicine, Department of Medicine, Division of Infectious Diseases, Birmingham, Alabama,1 University of Alabama at Birmingham School of Public Health, Birmingham, Alabama,2 Jefferson County Department of Health, Birmingham, Alabama,3 Centers for Disease Control and Prevention, Atlanta, Georgia,4 Birmingham Veterans Administration Medical Center, Birmingham, Alabama5

Received 14 August 2008/ Returned for modification 10 November 2008/ Accepted 22 January 2009

The optimal methods for the diagnosis of pharyngeal Neisseria gonorrhoeae infection are uncertain. The objective of this study was to define the performance of culture and nucleic acid amplification tests (NAATs) for the diagnosis of pharyngeal N. gonorrhoeae. In this cross-sectional study, males and females >15 years old who acknowledged performing fellatio or cunnilingus (in the previous 2 months) were recruited from three clinics (two human immunodeficiency virus clinics and one sexually transmitted diseases clinic) located in Birmingham, AL. The test performance of culture for N. gonorrhoeae, the Gen-Probe Aptima Combo 2 transcription-mediated amplification assay (TMA), the BD ProbeTec ET amplified DNA strand displacement assay (SDA), and the Roche Cobas Amplicor PCR was defined by using a rotating "gold standard" of any positive results by two or three of the three tests that excluded the test being evaluated. A total of 961 evaluable test sets were collected. On the basis of a rotating gold standard of positive results by two of three comparator tests, the sensitivity and the specificity were as follows: culture for N. gonorrhoeae, 50.0% and 99.4%, respectively; PCR, 80.3% and 73.0%, respectively; TMA, 83.6% and 98.6%, respectively; and SDA, 93.2% and 96.3%, respectively. On the basis of a rotating gold standard of positive results by three of three comparator tests, the sensitivity and specificity were as follows: culture for N. gonorrhoeae, 65.4% and 99.0%, respectively; PCR, 91.9% and 71.8%, respectively; TMA, 100% and 96.2%, respectively; and SDA, 97.1% and 94.2%, respectively. In conclusion, currently available NAATs are more sensitive than culture for the detection of pharyngeal gonorrhea in at-risk patients. PCR is substantially less specific than culture, TMA, or SDA and should not be used for the detection of pharyngeal gonorrhea.

* Corresponding author. Present address: W. G. Hefner Medical Center and Wake Forest University Health Sciences, Infectious Diseases Section, Medical Center Boulevard, Winston-Salem, NC 27157. Phone: (336) 716-3100. Fax: (336) 716-3825. E-mail: lbachman{at}wfubmc.edu

{triangledown} Published ahead of print on 4 February 2009.

Journal of Clinical Microbiology, April 2009, p. 902-907, Vol. 47, No. 4
0095-1137/09/$08.00+0     doi:10.1128/JCM.01581-08
Copyright © 2009, American Society for Microbiology. All Rights Reserved.





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