(P99-LB) Large surge in gonorrhoea diagnoses among heterosexual young people with a high proportion of throat infections

Introduction

The UK Health Security Agency recently announced a 21% increase in gonorrhoea (GC) cases in England in 2022, despite stable rates of chlamydia. Heterosexual GC diagnoses in Northern Ireland have increased by 894% in 16-19 year-olds and 305% in 20-24 year-olds between 2021 and 2022, respectively. The cause for this surge is unclear.

Methods

We conducted a retrospective analysis of our electronic clinical records across the Northern & Western Trust GUM clinics in Northern Ireland from January 2022 to March 2023 and collated all GC diagnoses and associated demographic data, including age, gender, ethnicity, sexual risk and laboratory results. In the Northern Trust we routinely offer throat swabs to all heterosexual patients for GC DNA (cobas CT/NG, confirmed with Xpert CT/NG). In the Western Trust, throat swabs are offered to those with anogenital GC and GC contacts prior to treatment.

Results

We observed 390 GC cases since January 2022, a 110% increase on the 2021 figures. More GC cases were heterosexual (n=200; M=100, F=100) compared to GBMSM (n=190). A high proportion of heterosexual GC cases had concurrent throat GC (67% of those who had throat swabs taken) and 11% had throat GC infection alone (n=22). Throat positivity increased with decreasing age. This case series included 5 cases of gonococcal conjunctivitis seen in a 4-month period; all were heterosexual teenagers with no apparent epidemiological links.

Patterns of age and throat GC positivity are presented in Table 1.

Discussion

The increase in GC cases seen in Northern Ireland far exceeds that observed from clinic-based diagnoses in England. Whilst cases are also rising among GBMSM, of particular concern is the sharp rise among the young heterosexual population. The extremely high rate of throat GC suggests that oral sex and deep kissing may both be contributing to an asymptomatic reservoir of infection, and targeted throat GC screening is warranted in this population. Further behavioural research is needed to explore the exact risk factors for both genital and throat GC infections in the young heterosexual population to determine if GC transmission dynamics resemble those seen in young GBMSM.