Oropharyngeal and genital gonorrhoea infections among women and heterosexual men reporting sexual contact with partners with gonorrhoea: implication for oropharyngeal testing of heterosexual gonorrhoea contacts

Background There have been very limited studies of oropharyngeal gonorrhoea in heterosexuals. Routine screening of oropharyngeal gonorrhoea is not recommended in heterosexual contacts of gonorrhoea. The study aimed to examine oropharyngeal gonorrhoea positivity among heterosexuals reporting contact with a partner with gonorrhoea. Methods At the Melbourne Sexual Health Centre (MSHC), all heterosexual individuals reporting contact with sexual partners with gonorrhoea are tested for genital gonorrhoea. In May-2017, MSHC also included screening for oropharyngeal gonorrhoea in heterosexual contacts of gonorrhoea. All contacts of gonorrhoea among women and heterosexual men between May-2017 and November-2018 were reviewed. Site-specific gonorrhoea positivity was also calculated. Results 191 gonorrhoea contacts (102 heterosexual men and 89 women) were reviewed. The median age was 28 [IQR=24-33] years. The gonorrhoea positivity in males was significantly higher at the oropharynx compared to urethra (18% [95% CI: 11% to 26%] versus 2% [0% to 7%]; p<0.001); and higher at the oropharynx compared to cervico-vaginal site in women (46% [35% to 57%] versus 36% [26% to 47%]; p=0.056). Of the 100 men who did not have genital gonorrhoea, 17 (18% [10% to 26%]) tested positive at the oropharynx. Of the 55 women who did not have genital gonorrhoea, 21 (24% [15% to 34%]) tested positive at the oropharynx. Infection at both the oropharynx and genital sites was not associated with sex worker status in women. Overall, 89% and 40% of gonorrhoea in heterosexual men and women were only in the oropharynx, respectively. Conclusions Oropharyngeal gonorrhoea testing among heterosexual contacts of gonorrhoea may be indicated given a substantial proportion of gonorrhoea contacts are only infected at this site.