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Gonorrhoea notifications and nucleic acid amplification testing in a very low-prevalence Australian female population

Passive surveillance has shown a rapid increase in the number of gonorrhoea (Neisseria gonorrhoeae) notifications in Victoria, Australia, over the past decade. About 17% of all notified cases are in women, and of cases in men, 71% are among men who have sex with men (MSM).1

Gonorrhoea notifications can occur from a positive culture or a nucleic acid amplification test (NAAT). NAATs are more sensitive than culture, particularly for urine sampling,2 which is the most common specimen type collected in Australia. However, NAATs for gonorrhoea are less specific than culture, and the specificity of NAAT varies by specimen type and testing platform, producing false-positive results that reduce the positive predictive value (PPV) when the prevalence of infection is low.3,4 The product information5 and United States sexually transmitted infection (STI) treatment guidelines warn against the use of NAAT in low-prevalence populations for this reason.6 In contrast, gonorrhoea culture has a specificity of 100%.7

A dual NAAT for the detection of chlamydia (Chlamydia trachomatis) and gonorrhoea infection was introduced in Australia in 2007, and is now substantially…