Nucleic acid amplification tests for the diagnosis of Neisseria gonorrhoeae in low-prevalence settings: A review of the evidence

Objectives: In UK Microbiology laboratories there is widespread use of nucleic acid amplification tests (NAATs) which allow the simultaneous 'dual' detection of Neisseria gonorrhoeae and Chlamydia trachomatis, although the prevalence of gonorrhoea in most areas is low and this may lead to high numbers of false positive results. The aim of this study was to examine the evidence base for unselected testing for gonorrhoea in the community.

Methods: A literature search was performed to review the use of dual testing in low prevalence settings by searching PubMed for appropriate terms linked to gonorrhoea diagnosis up to 1 December 2013 but without restriction of publication date. All publications with a prevalence of <1% were defined as low prevalence and included in this review.

Results: The publication search found data in low prevalence settings from three sources; genitourinary medicine clinics, laboratories outside the UK and from the National Chlamydia Screening Programme. The evidence base to support widespread screening for gonorrhoea was found to be limited and of variable quality.

Conclusions: We were unable to find an evidence base to support widespread screening for gonorrhoea in the community. However, the increasing availability of dual NAATs may lead to more testing but this should be tempered by the public health need. Pilot studies and development of robust testing algorithms should be encouraged.