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Basic & Translational Science

Category: Gonorrhoea - general

(P79) Oropharyngeal gonorrhea among men with symptomatic urethritis seeking treatment at government health centers in Kampala, Uganda

Tuesday, July 25, 2023
16:00 – 18:00 CST
Background

Pharyngeal Neisseria gonorrhoeae (pNg) infections, which are primarily asymptomatic, are a source of sustained gonorrhea transmission and play an important role in the emergence of antimicrobial resistance (AMR) in Ng. Africa has the highest rates of gonorrhea globally, but there are limited data on pNg infections in Uganda and other low- and middle-income countries (LMIC). Understanding the epidemiology of gonorrhea and AMR in LMIC is critical to developing disease intervention strategies.

Methods

We conducted a cross-sectional study to assess the prevalence of urogenital Ng (uNg) and pNg infections and antimicrobial resistance profiles in men with urethritis seeking care in government health centers in Kampala, Uganda from September 2021 to July 2022. Self-collected penile-meatal swabs and provider-collected pharyngeal swabs were tested for Ng by culture. Antimicrobial susceptibility testing was performed using disc diffusion. Participants were also tested for HIV. Demographic and behavioral data were used to perform a descriptive analysis of factors associated with pNg and/or uNg.

Results

Of 200 participants, median age 24 years (IQR 22, 31), 91% reported sex with women only, 60% reported “never” condom use, and 15.4% (30/195) were confirmed as living with HIV. The overall prevalence of uNg was 58.5% (n=117). Pharyngeal Ng was detected in 5.5% (11/200) of participants (all had uNg); the rate of pNg in participants with a concurrent uNg infection was 9.4% (11/117). Ng-positivity was higher in participants < 25 years (67%) compared to ≥ 25 years (49%) (p=0.001). However, participants with pNg were older (median age 29) than pNg-negative participants (median age 24) (p=0.002). There was no association between having uNG and/or pNG and HIV status, sexual orientation, condom use, or oro-genital exposure. Resistance ( >99%) to ciprofloxacin, penicillin, and tetracycline was observed; all isolates were susceptible to extended spectrum cephalosporins.

Conclusion

Pharyngeal Ng was more common in older participants and was relatively common in men that would have been considered at lower risk based on self-reported history alone. Prospective studies that also include women are warranted to describe the epidemiology, incidence, and resistance patterns of pNG, characterize barriers to reporting oro-genital sex, and identify factors for pNG to inform surveillance strategies.